The evolution of a physician's blog

Dr. Smith presents his research poster, which charts the tremendous growth of his eponymous blog, Dr Smith’s ECG blog. The blog is practically free to maintain, hosted by Google's service, Blogger.com, and will break 1,000,000 page views this year. The site itself represents a living and breathing, dynamic textbook: http://hqmeded-ecg.blogspot.com



Dr. Stephen W. Smith is a faculty physician in the Emergency Medicine Residency at Hennepin County Medical Center (HCMC) in Minneapolis, MN, and Associate Professor of Emergency Medicine at the University of Minnesota.

How to have a successful blog - with slow, steady growth

Tips from ProBlogger on how to have a successful blog:

- Regular useful content: Daily “how to” posts that solved problems and showed people how to achieve their goals, 90%

- Shareable content: inspirational posts, breaking news, humor, controversy, grand list posts, 5%

- Community: reader discussions, debates, polls, forum, 5%

- Email newsletter: collect people’s email addresses and send them weekly updates/newsletters

Here is a great quote from another blog: "Blogging is teaching, whether it’s yourself or others, and that’s the best feeling in the world" http://goo.gl/hCpF8

References:

2 Different Tales of Blog Growth. ProBlogger.

What is the minimal webmaster competence for running a medical blog?

"What is the minimal webmaster competence for running a medical blog?", asked a relatively new blogger recently. My suggestions are listed below.

Keep it simple, and free

If your blog content is great and compelling, you don't need much HTML, CSS, etc. knowledge. Knowing HTML doesn't hurt, of course, but it's not essential.

Keep it simple, and free. Many doctors are wrongly advised to spend time and money on custom installations of WordPress, hosting, and social media consultatants when all they need is a free Google/Blogger blog with a custom domain name.

"Blogging is teaching, whether it’s yourself or others, and that’s the best feeling in the world" 

Speaking from personal experience, my blogs reached more than 8 million page views and I've never used outside help for blog launch or maintenance. I don't think my blog content is that great or original apart from a few mind map diagrams, mnemonics and social media how-to articles - it's just my personal digital netbook that I share with the world.

I typically publish one post per day during the week at CasesBlog and AllergyNotes. They are scheduled 2-3 months in advance, and publish automatically, unless I edit them the day before they are due for posting.

"Blogging is teaching, whether it’s yourself or others, and that’s the best feeling in the world" http://goo.gl/hCpF8

Comments from Google Plus and Twitter:

Ahmad Gandour, Jan 25, 2012: This is a great advice i will consider starting a blog in the near future .you really post interesting post i check your post every day in the morning while i am checking journal watch and BEJM news letter thanks for these great post .

Ves Dimov, M.D., Jan 25, 2012: Thank you for your interest. I typically publish one post per day during the week at CasesBlog and AllergyNotes. They are scheduled 2-3 months in advance, and publish automatically, unless I edit them the day before they are due for posting.

Ahmad Gandour, Jan 25, 2012: Thanks for the info i booked marked the both pages i am going to check it every day

Ves Dimov, M.D., Jan 25, 2012: You can subscribe to the RSS feeds - this way there is no need to visit the website every day - the new post gets delivered to your RSS reader (Google Reader) or email.

Ahmad Gandour, Jan 25, 2012: Done :)

Jill Celeste, Jan 25, 2012: Blogger is the perfect tool for a doctor. Great post!

Heidi Allen @dreamingspires: What is the minimal webmaster competence for running a medical blog? casesblog.blogspot.com/2012/04/what-i… Keep it simple and free. Teach yourself and others

6 Reasons Why Doctors Blog

Here are the 6 Reasons Why Doctors Blog, according to Dr. John M., a cardiologist and electrophysiologist:

Here are the top six reasons why I and other doctors choose to author medical blogs:

1. The Practice of Medicine inspires
2. To educate
3. To better mankind
4. To give a look behind the curtain
5. To archive useful information
6. To display our humanness

My comment is here:

Thank you for the wonderful post and sharing insights, John.

Blogging "To better mankind" is beyond reach for me, I think. However, I hope that my blogs helped "To educate" at least some of the readers who flipped through more than 8 million pages since 2005...

Doctors are highly-qualified experts who limit their impact only to patients they see - if they don't publish, give lectures - and blog. In most cases, benefits far outweigh the risk and doctors should be encouraged to at least give it a try.

I tried to describe a practical and time-efficient approach here:

Social media in medicine: How to be a Twitter superstar and help your patients and your practice
http://casesblog.blogspot.com/2011/10/social-media-in-medicine-how-to-be.html

Blogging also keeps you grounded and humble. Critical comments prompt you to back your clinical opinion, expressed in a blog post, with solid scientific references and that's a good thing.

Comments from Google Plus:

Gary Levin, Jan 22, 2012: Ves, I agree with all of the above and welcome to G+ Let's hangout sometime soon. I will send you an invite..

Sherri Vance, Jan 22, 2012: Dr. Ves, I love your blogs. As for reasons why MDs should blog, I think the view behind the curtain (#4) is the most important. Given that our nation is weighing a myriad of conflicting viewpoints on how to fix our healthcare system, understanding these issues from the doctor's viewpoint is vital. Thanks! 

Carlo V Caballero-Uribe, Jan 26, 2012: Excelllent. I am sharing this post with my residents and students. They will discuss about it in a seminar. Many of #hscm its centered on engagement with patients and public its ok but engagement with your students and peers in several ways that social media offers its very important

As some example some of our use include:
Twitter for journal clubs
Google plus circles to clinical cases discussions
Google docs to edit papers
Slideshare for seminars presentations
Below in the link its a post about it in my blog. Sorry its in spanish but the translator helps.
Thanks for your posts and example.

http://carvica1.blogspot.com/2011/12/como-podemos-usar-las-redes-sociales-en.html

Blogging is good for you - and for most people who read blogs

From The Economist:

"Academic papers cited by bloggers are far more likely to be downloaded. Blogging economists are regarded more highly than non-bloggers with the same publishing record.

The back-and-forth between bloggers resembles the informal chats, in university hallways and coffee rooms, that have always stimulated economic research, argues Paul Krugman, a Nobel-prize winning economist who blogs at the New York Times. But moving the conversation online means that far more people can take part.

Despite the low barriers to entry, blogs do impose some intellectual standards. Errors of fact or logic are spotted, ridiculed and corrected. Areas of disagreement are highlighted and sometimes even narrowed."

Similar dynamics are in work on many medical blogs authored by physicians.

WIN-WIN, as the author of the blog "The Happy Hospitalist" likes to say.

References:

Economics blogs. A less dismal debate. The Economist, 01/2011.

A blog can help your career - and even if it doesn't, it's still good for you

From CNN:

There is strong evidence that people who use their blog as a career tool do better. In 2005, a Pew survey found that people who blog are generally higher earners. People who use social media end up finding jobs that are a better fit.

Changing your career and skipping entry-level positions can be easier if you have a blog.

Most importantly, a blog is a great platform for networking. Just look at this picture from the annual CME meeting Essentials of EM 2011.

A blog is a good way to meet other people who think like you do and who are in your field. It helps you to make real connections with them based on ideas and passions.

Social media use allows you to focus your connections on other top performers, since blogging about career topics probably self-selects for engaged and motivated people.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

The key concept is TIC, Two Interlocking Cycles:

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels (TIC).



Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.



Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs. Feel free to use the images in your own presentations with credit to AllergyCases.org.



References:

Blog your way to a better career. CNN.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Patients directed to online tools don't necessarily use them: 25% checked website vs. 42% read same material on paper. Am Medical News, 2012.

Comments from Twitter:

Julie Meadows-Keefe @esq140: Challenge is finding time.

A doctor admits: "I love to blog but I still don’t really know why"

From Mike Cadogan, the founder of one the most popular medical blogs Life in The Fast Lane, based in Australia:

I blog to vent, to educate, to converse, to cogitate, to archive thoughts and to stimulate discussion.

I love the concept of a launching a thought, an image, a moment… into the inferno of the blogosphere, and observing the response.

With the average blog-reader attention span being around 90 seconds, I find that most of my ‘good’ posts – thoroughly researched, with well constructed arguments and propositions… are lost on this ‘average‘ reader… Yet, strangely I feel better having taken the time to arrange my thoughts, review the evidence and archive the information.

The advent of Facebook and Twitter has changed the way readers comment and share, and in many cases the promoted discussion continues out-with the confines of the original medium…

I love to blog but I still don’t really know why…

My reply is here:

You blog because you have to, Mike. And we are lucky to have you as a writer.

I have more prosaic and simple reasons to keep several blogs focused on different aspects of clinical practice: internal medicine, allergy and immunology, pediatrics, and IT.

I simply blog as a way to keep track of the new developments in medicine that are relevant to my practice and patients. The blog is a digital notebook and an archive accessible from any place and device with an internet connection.

A lot of people find it useful and that's great but this is an added bonus. If I don't find a blog post interesting and useful, I don't hit the "publish" button. A custom-made Google search engine makes it all searchable in 0.2 seconds. It just works.

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."



Comments from Google Plus:

Neil Mehta - Loved your poetic post. I attempted to reflect on this earlier this year and came up with some reasons http://blogedutech.blogspot.com/2011/05/reflections-on-why-do-i-blog.html but find that it does not come close to your beautiful prose. Thanks for sharing.

References:

Why I Blog?
Why I Blog: Andrew Sullivan from The Atlantic Shares His Thoughts on Blogging
Why Do I Blog?
Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.
"One of the best decisions I’ve made in my career was to start a blog and a wiki, leaving a paper trail of ideas" http://bit.ly/GX7Z6C

Why you shouldn't close your blog and Twitter account

A few months ago, @Doctor_V and an anonymous doctor on Twitter had an argument, she closed her account and now DrV's blog is the only one left to tell the story: http://goo.gl/mIS3N

I understand and appreciate the arguments of both parties. However, when she deleted her Twitter account, we lost one side of the story forever.

All doctors should consider having online presence because they need to tell their side of the story.

For example, if the majority of pediatricians had blogs, the false autism/immunization link would not have become accepted by celebrities and misled a large part of the general public.

Comments from Google Plus:

Arin Basu: Excellent point by Ves about how false findings spread (read the bit about immunization and autism). I think by the same stretch of logic, I'd strongly vouch for clinician-epidemiologists, and epidemiologists should have their own blogs, and take part in social media more often and raise awareness about findings and interpretation of studies. Well said, Ves.

Related reading:

Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.

Blogging is a happy medium and it's never too late to start

Blogging helps you grow and meet wonderful people all over the world

"What have I learned as a blogger?", a 79-year-old blogger counts the ways:

1. Blogging gives me a focus

2. Blogging helps me stay young

3. Blogging helps me meet wonderful people all over the world

4. Blogging gives me an opportunity to grow

5. Blogging has the potential to create an income

It doesn’t matter if anyone reads it

From an interview of 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."



Doctor, you can be a Twitter superstar in two easy steps

Here is how to start a medical blog today: For doctors: How to start using social media. Indeed, you can be a Twitter superstar in two easy steps.

My advice for doctors who are interested in using social media for professional purposes is simple:

- Start on Twitter, expand to a blog as natural progression.

- Input your blog posts automatically to a Facebook like/fan page.

- Listen to the leading physicians, nurses and patients' voices on Twitter, and reply.

- Comment on blogs.

- Do not be afraid to share your expertise.

- Comply with HIPAA and common sense.

References

Is it Too Late to Start Blogging?

Why you should start blogging in 2011

Doctors are natural communicators - social media is extension of what they do every day

Doctors are natural communicators

My Google+ Circle labeled "Social Media in Medicine" now has 140 members - just one month after Google+ was launched. I think that's great.

Doctors are natural communicators and should do very well on social media platforms. Patients, and society in general, would only benefit from physicians who share ideas and focus on education.

Simple guidance for social media use

The suggested guidance for social media use by health professionals is very simple and based on a recent book by a nurse and social media advocate:

1. Remember the basics:

- your professional focus

- the laws around patient privacy (HIPAA in the U.S.)

- the professional standards of regulatory bodies and of your employers

2. After that, explore all the different social media tools that are out there.

Will Google+ have an effect on blogging? Undoubtedly. Will it "kill" blogging, as some have suggested? Of course not.

The Cycle of Online Information

Google+ is just another communication platform that fits nicely in what I called the "The Circle of Online Information" in 2009.

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:

1. Inbox for the web, receive information. Receive updates from selected RSS feeds (Google Reader) and Twitter accounts. See the list of suggested RSS feeds and Twitter accounts at the end of this post.

2. Digital outposts, share information on social networks. Share interesting links and ideas on the 3 main social networks, Twitter/Facebook/Google+, curate the inflow of information.

3. Get feedback. Get feedback from your followers on Twitter/Facebook/Google+, see what works.

4. Publish at your homebase, blog. Write a blog post using the ideas, updates and feedback from Twitter/Facebook/Google+. Expand on them. Aim for a blog post on Monday/Wednesday/Friday.

5. Share your expert opinion. Share the link to your blog post via RSS and the 3 main social networks, Twitter/Facebook/Google+. Go back to step 1 to continue the circle.

Different styles/same goal

The two videos below show different communication styles but both are authored by physicians who use social media as extension of their everyday practice - they educate patients and colleagues and address their questions and concern.

The first video is by an orthopedic surgeon and the second by a pediatrician. They are both gifted natural communicators.


Do your patients speak "Doctor"?


Seattle Mama Doc 101 - Teething and Fever

RSS bundles of medical news

You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my Google Reader account. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Add your own comments to some of the tweets.

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

Comments from Google+:

Sina Neda - Good to see that the medical community is gathering on Google+, I'm still trying to find interesting people to follow in the medical field. Also want to remind everyone that is interested in MED-networking to add your Google+ and Twitter handles on the following list.

Neil Mehta - I for one would be very sad to see blogs go away. I find them to be the best place for "quiet" reflection, where you can think, write, cite, and then present to the society for feedback - a good example for social constructionism.

Art Gross - Every new social platform is always said to kill blogging. So far none of them have. Blogging is where content is created. Twitter, Google+ is where it is shared. Although the feedback on Google+ adds a new dimension and one that should add value to blogs. BLOGGING IS NOT DEAD YET! :)

Ves Dimov - "Blogging is where content is created. Twitter, Google+ is where it is shared." - Example: "The circle of online information"

Arin Basu - To some extent Google plus is essentially a microblogging/lifestreaming platform. As you wrote, it will change blogging but don't see how blogging will go away.

Related reading

Assessing Patients' Interest in Social Media: 83% used it, 56% wanted providers to use social media http://goo.gl/yD63V
The central part of medicine is patients - don't push them out of social media

For doctors: How to be a Twitter superstar in two easy steps

How to deal with the information overload from blogs, RSS and Twitter?

29 Debates About the "Right Way" to Blog

For doctors: How to start using social media

Bloggers: Google+ is coming to annihilate you
What are the Downsides of Social Media for Doctors? Dr. Wes shares insights from 6 years of blogging

Image source: OpenClipArt.org, public domain.

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."

@DrVes: New trend: Hospitals tell doctors-in-training point-blank during orientation: "Don't blog. Don't tweet." Consequently, interns close blogs and Twitter accounts (confirmed via email from a trainee).

@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.

Related reading

Why I became an oncologist - by the president of the American Society of Clinical Oncologists - a patient defined his professional life. CNN, 2011.

Patients can teach us so much. We must pay attention. And yet some people want to silence their voice on blogs and Twitter.
Keeping all regulations in mind, a medical student soon finds there is nothing to blog about: http://goo.gl/541pj
HIPAA found in Hippocratic Oath: Keep the patients’ secrets a secret. Also: My colleagues will be my brothers and sisters http://bit.ly/pGObLI

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
- Consider using your name and credentials on your blog and other social media accounts
- 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.