I once knew a blogger tormented by a troll.  I suggested that he disable his comments.  “But then it wouldn’t be a blog,” he whined.

Says who?

I must have missed the email suggesting that blogs have to have comments.  Apparently Seth Godin missed it as well (you can read why he disables comments here).

Perhaps comments don’t often add much to a blog (The only exceptions are the universally insightful comments left here on 33 charts by my readers, the greatest minds in social health).  True conversation, after all, is a dying art.  And despite our social obsession, broadcast is the order of the day.  But if you get beyond the platitudes and self-promotion, comments can (all sarcasm aside) have value.  Great comments make a post stronger.

When you think about what a blog should look like, keep in mind that the concept and definition of a blog is a moving target.  The standards of the past don’t hold today.  Early blogs, for example, were rants.  I remember reading advice from a ‘guru’ at the time who suggested that deliberate misspellings, poor grammar and strategically placed profanity raised your credibility.  It made you … authentic (at the time this was a revolutionary quality).

Advice to my blogger friend:  Worry less about your disabled comments.  Consider yourself a maverick.  And work to create content so remarkable that the commentary carries on elsewhere.

Last week Robert Scoble announced on Cinchcast the fresh news that his son Milan had just been diagnosed with autism.  I often listen to his Cinchcasts and the disappointment in his voice was heartbreaking.

Then I began to wonder:  If one of my children were to receive a devastating diagnosis would my first impulse be to share the news on a public platform?  Probably not.  And that, among a number of obvious things, is what differentiates me from Robert Scoble.

Everyone’s got their transparency threshold.  You can see it with attitudes surrounding location applications.

The importance of community to each of us varies tremendously.  I see it among people with their own health.  And its no different with our sick children – some of us start blogs, Facebook groups and even national movements surrounding the issues of our kids.  Others prefer the private support of family alone.

And social media has nothing to do with this.  The urge to reach out or withdraw is human and individual.  It’s unrelated to technology.  Social media just amplifies the effect of those who choose to reach out.

I can’t speak for Scoble but from having read (watched, and listened to) him for a number of years I suspect his online relationships are pretty important to him.

I wanted to say that it took a lot of courage to sit at a microphone and share his news.  But that’s my more private perspective.  For Scoble, it’s what he does.

This is cool:  33 charts made it onto Alltop (as my badge on the right says, I don’t know how I got there either).  If you don’t use Alltop you should check it out.  It’s a blog aggregator that has the look and feel of magazine rack.  Alltop is the brainchild of Guy Kawasaki.

What’s remarkable about Alltop is its clean, simple feel coupled with real back-end functionality.

33 charts is listed under health and social media.  I’m hangin’ alongside such social health luminaries as Val Jones, Kevin Pho, Wes Fisher, Paul Levy and Kim McCallister to name just a few.

You can check out my personal Alltop page here to see what I’m reading.

And do me a big favor.  When you get your own page, add 33 charts to your list.  I don’t wanna be at the bottom of the rack forever.

Yesterday morning I watched two physicians on Twitter carry on about mosque real estate in lower Manhattan.  Each took opposing sides and the dialog was just what you’d expect.  It wasn’t flattering.

The unfortunate thing is that both are pretty visible physician figures.  I’m guessing they’ll never relate to one another quite the same way again.  Such stark differences in ideology are hard to put aside.

You might argue that Twitter is a free platform and you should talk about whatever you want.  We’re told that transparency is a virtue.  Disclosure is all the rage.

Not always.

When it comes to politics and religion, transparency can be a liability.  Social spaces are public spaces.  If you are interested in growing relationships with those who hang here, you should probably keep some things to yourself.  The discussion of sensitive issues will invariably alienate followers.

As physicians there are very few of us in social media.  We’re visible ambassadors of a new medium that’s revolutionizing the way we relate to one another.  Leave the loaded dialogue to political pundits whose careers are built on polarity.

I recently got into a discussion with a couple friends about doctors and blogging.  Why don’t we more doctors out there?  Of the hundreds of thousands of doctors I’d expect more taking a voice.  Even during the U.S. health care reform debate.  Crickets.

Of course there are doctors who blog, but the numbers are slim.  What’s behind it?

Passion.  Pushing great content requires a passionate interest in changing ideas and making a difference.  There’s malaise in medicine right now.  Margins are slim.  Physicians are losing control of what’s happening around them. The fire in the belly that drove so many doctors to choose medicine has given way to a preoccupation with survival.

Late adopters.  Most doctors think a blog is something that deviant teens do on a cell phone.  There’s endemic ignorance in the medical community surrounding social technology.  Can we teach ‘em?  Maybe.  But I think this is a generational issue that will work itself out with time.  The use of social technology to facilitate dialog between doctor and patient will evolve over the next several years as 1) technology evolves and 2) digital communication becomes a standard.  Keep in mind that many of us still work with doctors who grew up using rotary phones.

They don’t need the business. Sure there are the tummy tuckers and the lapband docs who are lobbying for customers.  But for most primary care doctors, the market is such that more patients doesn’t necessarily add up to a healthier bottom line.

They don’t have a business.  Physician practices are folding faster than beach chairs at high tide.  Consolidation of medical business will mean that personal and practice branding will take a back seat to hospital and clinic marketing.  If it hasn’t happened already, your small town solo practice doctor will be working 9-5 under a hospital or large managed group.

Blogs are so…2000. Communication is moving closer to real time.  The revolution that started as Moveable Type has given way to new platforms.  Blog entries are becoming shorter and lifestreaming applications like Posterous gaining ground.  I see more physicians finding their voice in the fast moving streams of Twitter and Facebook.  Maybe these better suit the mindset and lifestyle of today’s doctor.

As the medical profession is redefined and resurrected expect excited, passionate voices to emerge.  I’m just not sure that the weblog will be where those voices will live.

It’s a post you’ll see periodically:  Blogger goes on vacation and goes dark from his blog and Twitter.  This spawns the requisite post detailing how nice it was to be away.  Refreshed and all the stronger, we hear about the lessons from playing parchese, listening to the crickets sing, and ignoring the purr from Tweetdeck.

This week I have been on vacation but I didn’t necessarily unplug.  I screened for critical emails once a day.  I had prewritten and scheduled a couple of posts but they didn’t require much maintenance.  Besides that I was too busy boogie boarding, kayaking and eating crab cakes to really look at Twitter.

But what was totally unexpected was the fact that we spent a fair bit of time on Facebook.  I’m not a huge Facebook person but my wife had picked up on the Hilton Head Island Facebook page and it turned out to be an incredibly helpful resource.

We were cued in to the location of dolphin sightings, an unexpected prediction of the northern lights, insight on a concert/fireworks display at Shelter Cove as well as tips on a number of off-the-beaten-path restaurants that even our concierge didn’t recognize (check out Signe’s for lunch).  Listening to the island’s dialog take place from both innocent visitors and experienced insiders gave us a real feel for certain things to do or avoid.

And I felt neither connected nor disconnected.  Our use of Facebook in this context was neither an obsession nor a business obligation.  It was pretty natural.

In his new book, Cognitive Surplus, Clay Shirky makes the point that the divide between being ‘online’ and ‘offline’ may be evolving as a thing of the past.  He tells us, “Our social media tools aren’t a alternative to real life, they’re part of it.  They are increasingly the coordinating tools for events in the physical world.” Two worlds once divided are increasingly becoming one.  They feed off of one another.  I felt it this week.

There’s no question that Twitter can be a jealous mistress.  Social’s draw can create an unhealthy preoccupation for some.  In that case unplugging is probably the solution.  But I suspect that as time passes this ‘now I’m in/now I’m out’ dichotomy will give way to a more balanced, healthy relationship with our networks.

I read Crush It earlier this week on a flight from Houston to South Carolina.  This really quick read written by Gary Vaynerchuk shows how to leverage social media tools to push your personal brand to the next level.

So you’re thinking, “DrV, what’s a doctor like you reading a book like Crush It?  Isn’t that for crazy, fast-talkin’, wine-pushin’ internet entrepreneur types?” No, actually.  While Vaynerchuk uses his personal story of Wine Library TV as the foundation of his book, his core principles apply to just about anyone with a message, mission or goal.

And I think that’s most of us.  Even doctors (Crush It actually references pediatricians once and vaccines twice).

Vaynerchuk’s easy voice and straightforward advice make the book immediately applicable.  In fact, Crush It has motivated me to experiment with other forms of media – I’ve realized there’s so much more I can do to push my message.  Look for me to experiment in video and audio in the very near future.

If you’re planning to go beyond where you are now, read Crush It.  Too many great points to make here but one thing that struck me is Vaynerchuk’s three simple rules:

Love your family.  Work super hard.  Live your passion.

Good advice for anyone … even a doctor.

For the observant eye, you may notice that things look a little different over here.  That’s because 33 Charts is now housed on WordPress/Thesis.  With the help of Nico Pin at SnowyDay Design my content was successfully from Typepad last week and the big server switch occurred tonight.

But we’re still looking for bugs.  Between migration of content from Typepad into WordPress and the migration of the site onto my new server there may have been some comments that got lost in the shuffle.  If you find something missing, just let me know and I should be able to dig it up from my Typepad account.  If you see anything weird happening (or not happening) please give me a heads up.

So why the change?  After all, it doesn’t look much different.  While I liked Typepad’s ease of use and service, I felt that I wanted more latitude in customizing the look and feel of the site.  It’s pretty bare bones right now although I’m planning more creative use of my sidebar as well as the addition of pages that will make it a more complete representation of me.  I just found Typepad too constrained for where I want to go.  These changes will appear on 33 Charts over the next few weeks as I get used to the platform.

So pardon me as I complete renovations here and don’t hesitate to tell me what you think I should or shouldn’t build into the site.  I’m thinking I need something at the top of the sidebar with my name and picture.  I’ve been told that passing visitors really have no idea that this is a blog written by a doctor … or even a human.  I need to work on that.

I’m sensitive to the visual assault that readers are confronted with on today’s busy blogs.  I’ll continue to do my best to keep it clean, minimalistic, and focused on unique content.

Let me know what you need and thanks for reading.

It’s been a tough week for the anti-vaccine movement but an important week for pediatric health. Yesterday the UK’s General Medical Council announced that Andrew Wakefield, who’s fraudulent manipulation of data spawned the vaccine-autism cottage industry, would be ‘struck’ from the medical register. This action by the GMC is one more nail in the coffin of the man who has singlehandedly turned back the clock on two generations of pediatric public health. Check out Respectful Insolence for some pithy commentary and a pointed, must see interview with Matt Lauer. This issue finally seems to be circling the drain.

Speaking of vaccines and blog-driven children’s health advocacy you should keep one eye on Liz Ditz. She’s a relentless advocate for those who can’t advocate for themselves: specifically children and their immunizations. See Be Hepatitis B Free, a nice post detailing efforts and promote Hep B awareness. You’ll find her beating the drum on
anti-vaccine propaganda on Twitter. She’s my litmus for key issues in this area

Another hot-button topic has been the personal genomics kerfuffle brewing over the FDA’s decision to investigate manufacturers of personal genomics testing kits. You can hear Tom Goetz (author of The Decision Tree) argue the
pro-position on his blog during a nice interview with KQED. Opposing is Marcy Darnovsky from the Center for Genetics and Society. I recommend everyone peek at The Decision Tree for a taste of medicine to come but as I’ve said, I’m not hot on Goetz’s push for personal genomics. For another alternate view, see our friend Berci. Nuts for Healthcare also has a nicely linked comprehensive overview of the issue.

Artsy Docs

If you’re fed up with the echoes of the reverbosphere blogosphere and want original stuff to make you think, check out Dr. Charles and his original thinking on The Examining Room of Dr. Charles. See White Silken Ribbons for thoughts on his medial school cadaver brought on by the appearance of a young patient’s skin.

And Wes reminds me of Dr. Charles … except with an RFA catheter.

Interestingly, I was paged this past weekend from the ER with a frighteningly similar situation to that of Dr. Wes in Hauntings. Non-physicians will never understand these feelings but this post is a start. While you’re there, read Damn Doctors. In an increasingly patient-centered world, this post with its literary flare and open-ended conclusion made me think.

Musings of a Distractible Mind strikes a similar note in Healthy Exchange. Rob tackles some of the broader questions surrounding why we socialize as physicians and how social media influences health care. His stream-of-consciousness format makes up for some heady subject matter. And if you’re prone to audio, check out his podcast.

And no discussion of original physician voices would be complete without mention of Bongi. This story of how esophageal varices due to bilharzia lead one lucky patient to learn Afrikaans. (Tip for those on this side of the pond:  A theatre is where surgeons operate)

While you wouldn’t believe it after reading Bongi, I’m hot on the idea that technology is progressively marginalizing the role of the physician. Kevin MD pulls together an interesting discussion surrounding the Da Vinci robot in Are da Vinci Surgical Complications the Fault of the Robot? My initial impulse was, ‘of course a robot can’t operate as effectively as a human.’ But it seems robots or their operators haven’t been properly trained. This is a fascinating topic and fully loaded. Look for me to chime in on this soon.

Facetime with patients may be soon out of vogue according to Alan Dappan. But not really in a bad way. Alan Dappan has a nice post at Better Health on the power of telehealth that’s worth a look.  Remind me to dive into telemedicine when I have the time.

And for a little madcap doctor fun, check out Facebookville General Hospital by Mike Cadogan at Life in the Fast Lane. My fav: The plastic surgeon.

Patients and things

While many doctors sit watch, the patient community is busy shaping the future of health care. Ted Eytan MD, not one to sit around, has an interesting guest post on the different levels of engagement by e-patients. Admittedly I’ve always argued that all my patients are e-patients but the pyramid presented in the post reminds me that not all e-patients are created equal. I wonder if there’s a pyramid for physician involvement in shaping the future of health care? If you find one, let me know.

Patients revealing their personal health information has become something of an art form these days. While I’ve always suggested that this may come with a cost, the e-patient movement is beginning to raise questions. Susannah Fox’s post on e-Patients.net, A New Conversation About Health Privacy: Who’s In? raises some interesting issues concerning health privacy in light of the Facebook mess. Every physician should read e-patient.net to understand how health care and patients are changing. And it seems that the patients may be getting ahead of us.

Along the lines of e-patients I was pointed to Stephen Wilkins’ 12 Questions Empowered Patients Should Ask When Looking for a New Physician. All great questions that 21^st century patients should consider but I’m guessing this is a one-hour discussion – and when should that happen? Maybe it should be part of every physicians site/blog? Perhaps this is an inside-the-bubble question reflecting the e-patient/doctor disconnect. You tell me.

And do you know the difference between and e-patient and an i-patient? If not, read Laika’s MedLibLog.

In the category of patient driven data comes a really interesting post from Diabetes Mine. Amy tells us about Manny Hernandez and his diabetes monitoring application TuAnalyze. In partnership with Children’s Hospital Boston TuDiabetes.org has developed an innovative new A1C mapping tool called TuAnalyze with support from the US Centers for Disease Control and Prevention (CDC).

It works this way: members to submit their Hemoglobin A1C data. The information submitted gets displayed in a community map on TuDiabetes, with states lighting up according to the aggregate A1C data once a threshold of participants in each state is reached. Patients can track their own A1C and compare it with others. Over time it will be interesting to see if participation in social networks correlates with diabetes management on a large scale.

And speaking of behavior management, check out Jay Parkinson’s post on SnuzNLuz just for fun.

Now around the web in 60 seconds

And now for something completely different. From the category of creepy imagery harkening back to a time when doctors smoked, there’s Morbid Anatomy. Check it out.

If we can believe Dr. Shock this week I score pretty high in the empathy department but I think I’ll let my parents be the judge.

See Becca Camp’s blog, Sent From My Teleportation Device, for the premedical student’s stream of consciousness. She’s got some good ideas and interesting links. What would you be doing in social if you were a premed student?

For a taste of medical disruption be sure to check out Dr. Rich’s suggestions for Black Market Healthcare. Talk about disruption.

Ed Bennett birthed a new list of hospitals using social media on Found in Cache. Always fascinating and makes great fodder for social media presentations. Full disclosure: I’m Ed’s number 1 pitchman when it comes to his hospital list.

While I thought anonymous physician bloggers went out of style with Flea, actually there’s a blog from a mystery author at Atlanta’s Grady Hospital. I found some of the posts a bit long for my taste but the voice is genuine. I can be critical because he/she/its anonymous.

Check out Scope, Stanford School of Medicine’s blog which has seen remarkable growth over the past few months. And for good reason. John Stafford’s team of writers are pumping out some sharp, to-the-point content that keeps me in the know on critical issues of medical science. Scope has become a key piece of my digital signal.

I hope you enjoyed this edition of Medical Grand Rounds.  Be sure to look for me on the Doctor Anonymous Show on June 24, 2010 at 9E/8CT.

I’m your humble host for Grand Rounds next week. The theme is a secret. Actually, it isn’t a secret. I just haven’t decided on a theme yet but I’m sure I will between now and next week.

I’m thinking something along the lines of evolving memes in social health. I’m transiently preoccupied with how Health 2.0 has impacted the doctor-patient connection. If you see any good med student stuff be sure to let me know. I want patient stuff as it relates to providers. I’m unlikely to read anything that’s long.

Bottom line:  If you have something that you think is worth everyone’s eyeballs, let me know about it. And this includes stuff that other people have penned.  Be my eyes and ears.  Be my human signal.

Disclaimer: If I don’t link what you send me, it only means that it didn’t fit in with the theme that I created five minutes before I put the post together. It doesn’t mean that you’re not brilliant. It doesn’t mean that I don’t love you.

Send your submissions to fox42    aT  me.com by late Sunday U.S. time