Public Doctors. Public Thinking

November 26, 2012

I’ve been thinking about doctors who think out loud.  Public thinkers.

What I’m referring to is doctors creating content and having conversations in areas where everyone can see.  Writing blogs, creating videos, creating e-books, or curating links on Twitter.  It’s a term that involves not just social dialog but the individual creation of retrievable content allowed by new technology and the democratization of media.  Public thinking is our presence outside of the exam room beyond the traditional confines of what we consider a doctor doing.  It involves the dissemination of ideas outside of the confines of traditional filtered media.

I like the term public thinking because it reflects the general opening of our ideas and conversations that mark the networked age.  I’m a public doctor.

What are the advantages of sharing our ideas?

  • Transparency.  We are better understood when people see how we think.
  • Connection.  When we share our ideas, people find us.
  • Spread of ideas.  When good ideas are shared, they are discovered and built upon.

The reason the concept is worth discussing is that most doctors aren’t public with the way they think and work.  We’re trained to contain what we ponder and believe.  Medicine fosters a permission-based culture.  This silo mindset is incompatible with a knowledge economy where ideas are the new commodity.  Steven Johnson tells us that the most innovative ideas throughout history have resulted from networks of creative people collaborating and challenging one another to explore the adjacent possible.  It’s how we begin to solve problems.

Public thinking needs thought and dialog.  It needs role models and a structured approach for medical students and digital immigrants alike.  The medical leader of tomorrow will think out loud and trade in the currency of ideas.

We have to understand that the evolution of our profession in a networked world involves attention to our public thinking.  The way we handle ourselves in the digital space is very different than anything we’ve been trained to do.

I’m building this idea for project currently underway.  What are the advantages for public thinking?  Does ‘open thinking’ capture the concept better?


{ 19 comments }

Kirsten Ostherr November 26, 2012 at 12:51 pm

“Public thinking” for doctors is like “public intellectuals” for academics. This term has gained currency over the past decade or so as more academics – people like Cornel West, Edward Said, and Henry Jenkins – have found that they want and need to adapt the ways they convey their ideas in order to reach a broader audience. Often, people are motivated to become “public intellectuals” because they work on issues that are pressing social concerns, that need dialog beyond the confines of the university silos. Of course, the idea has been around for a long time in different forms – thinkers like Ralph Waldo Emerson, or William Osler – come to mind. I think we need more public intellectuals who are doctors, and your concept of “public thinking” moves things in the right direction.

DrV November 29, 2012 at 4:28 pm

Thank you, K. Nicely put. I need to study this broader historical context of public thinking.

Gregg Masters November 27, 2012 at 12:18 pm

Bryan, having been there at the beginning with you, I know, you know the answer to that question. It was and perhaps remains one if not the principal attractions to this medium, ie., an expanded ideation and collaboration gene pool. Nothing has changed. The clue train manifesto is as still compelling as when first released in 1999. Conversations are remain ‘markets’ if not of the increasingly polluted variety. The 95 theses remain intact, and the best and brightest assuredly do not work in your company, yet they are routinely accessible in the crowd. Long time no chat. Hope all is well. Any thoughts on secession?

DrV November 29, 2012 at 4:31 pm

If we succeed I’ll still have my Twitter community. And thank you for your insight. All agreed. And yes, we must catch up.

Gregg Masters November 30, 2012 at 4:10 pm

Ditto!

Here’s the clip: “Physicians and Social Media: Trends and Tea Leaves’ circa 12.8.09:

http://www.blogtalkradio.com/2healthguru/2009/12/08/physicians-and-social-media-trends-tea-leaves

FYI: my @DocTweets twitter handle is still ‘in jail’ while DocTweets.com lives on in a somewhat dormant state. Waiting on twitter….

GlassHospital November 27, 2012 at 1:24 pm

I’d love to know more about the project.

I’ve felt for a long time that doctors have a duty to engage in advocacy. Many refute this notion, arguing that doctors have no special claim to erudition or civic virtue.

I like the idea of doctors as public intellectuals, as in Kirsten’s comment. Why the need to separate us out as “public thinkers?” Though being labelled a ‘thinker’ is less off-putting than being an ‘intellectual’ (well, at least in certain crowds).

–Dr. John

DrV November 29, 2012 at 4:37 pm

Yes, we can argue about the language but the point is to get us thinking out loud and in public. I agree that intellectual may not be right since some of this dialog may not necessarily be characterized that way. Thinker is good. Open thinking is another.

Sherry Reynolds @Cascadia November 27, 2012 at 2:09 pm

As we also move from the individual to the community levels of conversation I wonder if we not only need public “thinking” but the intellectual “space” to hold the conversations – Communities of Practice -

The CDC for example has a new CoP where providers can “learn, share expertise, and work together on solving common problems in their communities’ focus areas” http://www.cdc.gov/phcommunities/

A number of us in health IT are working on this at the National level for patients, providers and other parts of the care team.

Trish November 28, 2012 at 9:24 am

I think the greatest potential of “public thinking” is to move beyond the silos – whether the silo is a department, a facility, a healthcare network, a professional association, etc. When the dialogue is open, ideas may be introduced that were not initially a consideration but which can provide valuable insight in reaching the most effective potential solution. “Public thinking” dramatically improves the ability to “think outside the box” because the participants in the dialogue may come from different “boxes”. Potential solutions can be reached more quickly due to the (nearly) real-time ability to share data and collaborate. The development lifecycle can also be accelerated because testing the same solution in different environments can reveal varied strengths and weaknesses more rapidly. The question then becomes how to harness the constantly expanding pool of data so that it can be accessible and useful; the intellectual “space” referenced by Sherry Reynolds may be very helpful in harnessing the data.

Ted Eytan MD November 29, 2012 at 7:39 pm

Dear Bryan,

Great question, that I have thought about a lot as I’m sure you have:

1. Should we talk about whether doctors “should” do this or whether we have an obligation to because

(a) Most of our educations are paid for by tax dollars
(b) Society’s expectation of us is to lead the health system (and not in a authoritarian way, a servant leader way.
(c) It is critical for us to know what we don’t know, to the best of our ability. I think this is a core principle (for me anyway) in the specialty of family medicine.

This is something my generation found experientially in the profession’s handling of the AIDS epidemic (see this Flickr photoset for images of what that looked like: http://www.flickr.com/photos/genyphyr/sets/72157606981989354/ ). It was my no-turning-back moment, when I saw how the profession I was to go into could exist behind closed doors and not be there for people who needed help.

2. If physicians are trained and practice in a world where this expectation is set, will it change the caliber / type of person that applies to medical school, to a person who is more likely a healer/leader/partner and an enterprise thinker?

I have said (and blogged) frequently that – I’m not that smart and my ideas aren’t that unique, and, if someone is doing something better than me, I’d like to know about it.

I can’t imagine a world today where I would not be allowed to live these experiences in service to our patients,

Ted

Gregg Masters November 30, 2012 at 4:05 pm

You rock too Ted! Humility and open…come to mind.

DrV November 30, 2012 at 4:41 pm

Thank you, Ted. Multiple facets there for further dialog.

Physicians have let Health 2.0 pass them by IMHO. By not responding to the forces in health care we risk irrelevance. We’re forsaken our leadership role in not fulfilling our duty to participate.

To your point about changing the caliber of medical school applicants, wouldn’t it be cool if public contributions/participation/creativity were considered in choosing eligibility for enrollment? Now that’s got me thinking…

Thanks for your thoughtful contribution.

JackWilshere December 3, 2012 at 1:37 am

Greetings! The site is great. Thank you for a great resource

CrystalMD December 7, 2012 at 7:10 pm

Great post, as usual. Uniquely reiterating why doctors should have an online presence, and consequently become “public thinkers.” Contrary to most opinions expressed here, IMO, “Public thinkers” resonates better with above mentioned Transparency, Connection, and Spread of ideas. :)
The word public can have so many interpretations, such as, thinking out aloud (as you mentioned), of the public, for the common people, for everyone, etc.
What’s out in public is definitely Transparent- everyone can see it.
What’s out in public builds Connection; multiple people see, they share opinions, find commonality; hence, connect.
And lastly, What’s out in public will obviously help in the spread of ideas because its out there!
Played a lot with words here, but hope I made sense!

Rohini Sigireddi December 8, 2012 at 1:09 am

Vartabedian touches on the issue of public thinking by today’s physicians. Public thinking encapsulates the need for doctors to have a role outside of the clinic and one-on-one doctor patient communication. Public thinking by patients and physicians can service the modern patient’s demands for transparency and a constant connection with the medical world.

Modern patients demand openness and transparency by their physicians, as modern patients demand a more active role in their medical treatment. No longer are patients willing to accept the advice of physicians without question. Dr. Eric Topol notes in his text, The Creative Destruction of Medicine, that during the course of his medical career, he witnessed the shift in patient preferences from demanding a prescription at the end of a doctor’s appointment, to attempting to avoid pharmaceuticals at all costs. Patients are not willing to blindly accept the word of their physician, they wish to understand their physician’s rationale for suggesting a certain medical treatment, and often counter that suggestion. Public thinking would allow for more understanding of physicians, by their patients, which would hopefully lead to patients trusting medicine and physicians more.

Additionally, modern patients wish to be connected with the medical world at all times. Given the rise of technology, many consumer applications have emerged, which allow patients to track their health status, access medical information in encyclopedia form, and transmit information to their health care providers in the form of text message and email. Public thinking about medical conditions by patients and physicians may help to better connect both parties and improve health outcomes.

DrV December 10, 2012 at 5:24 pm

Thanks, Rohini. Public thinking in medicine truly is consistent with the changing relationship that docs and patients share. Going forward, transparency will likely be viewed as a favorable physician attribute, certainly for teachers and those looking to influence.

Katharine Yang December 10, 2012 at 4:37 pm

Hi Dr. V! Thanks for the thought-provoking post.

I, too, believe that public thinking captures the idea you described more accurately than open thinking. Public thinking attaches the idea to the wider, public community, while open thinking depends on the context it is in (which could be the medical field, the academic field, or the public).

When reading your post, two couple components/questions came to mind:
1. First, public thinking is definitely something that should be encouraged as it makes for a more dynamic medical community, where those who are involved can learn from others’ mistakes, where ideas can grow from international collaboration, where less time can be used on ideas that have already been formed. For me, to really understand public thinking, would you mind describing what kinds of things you would like to publicly communicate as a physician? Is what you’re thinking about similar to a site like KevinMD.com?

2. Second, I agree with one of the previous responses in that having a platform for such dialogue between physicians and a reach towards the public is important for its success and impact. In order for a social media endeavor to be readily accessible and relevant to the patients in the public, perhaps each hospital or medical institution should have a site in which physicians could write about their concerns about things ranging from problems at the hospital to medical care issues in general. Perhaps dialogue on the site could cause change in policy at the hospital administrative level. Public input would be beneficial in not only allowing the patient to be more educated about their care, but also for physicians to see what their patients think in an anonymous way. One of the hardest things to do to have retention for social media sites is to have some sort of incentive or purpose for a target audience to continually visit the site. Having such forms of media be localized to institutions might encourage a continual patient following of such hospital blogs/forums.

DrV December 10, 2012 at 5:20 pm

Thanks Katharine. Most medical communication is permission-based and occurs on platforms intended for finished work. I see public thinking as thinking shared and discussed before it’s fully formed. Ideas that are in evolution. I think that what happens on many physician blogs fits this criteria although some blogs do gravitate toward the polished. Much of the dialog that happens in real-time is public thinking. Information delivery, communication and sociality are inextricably bound, as Harvard’s David Weinberger has suggested.

I don’t have any particular agenda, necessarily, and I think this kind of openness can work for everything from policy to education reform and bench research.

What I do here is what I would consider public thinking.

It’s a concept that I’m hashing out….with you! Thanks for your insight.

Peter Cabeceiras December 12, 2012 at 4:01 pm

Whenever I shadow a doctor, I can always count on them bringing up an idea or insightful suggestion that would benefit the patient or eliminate some form of waste. They form these ideas through their passion and years of experience. I always wondered what would happen if they shared those ideas beyond me and their colleagues. Those ideas would combine with other ideas and eventually bring about a change for the better. I think it would greatly benefit medicine if doctors became more involved in “public speaking” because no one group of professionals can solve the complex problems involved with healthcare. If doctors can convey more of their thoughts and opinions to a widespread audience, then they are also opening up the opportunity for collaboration. Once the message goes out to and inspires an eclectic group of professionals, a team of people with all of the necessary distinct perspectives on medicine can tackle the problems that healthcare faces today.

If doctors shared their thinking publicly more often, I think patients would also take time to listen. In this era of connectivity, patients want more ways of communicating efficiently with their doctors. Very few patients are chatting online with their doctor on a daily basis, but they would probably be interested in following what their physician has to communicate. The e-patient can do research and learn how to better manage their condition through the internet. An additional resource for the e-patient could be having this outlet online where their physician can easily communicate with them.

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