Check out the facelift on Scope, Stanford School of Medicine’s blog.  Their new look is clean, easy on the eyes and custom built for the efficient consumption of content.  And I love the big, soft social sharing buttons at the end of each post.  I just wanna push ‘em.

Under the direction of John Stafford, Scope is one of my leading destinations for the serendipitous discovery of new medical information.  While there’s lots of Stanford related material (and there’s nothing wrong with that), they manage to capture the best of the rest.  If you are a medical school looking start a killer blog, study Scope.

I think I’ll put my feet up and try out those buttons.

 

I love finding new physician voices.  Here are a few that I’ve been peeking at over the past couple months.  They’re worth checking out.

Linda Pourmassina.  Linda is an internist in Seattle and one of the finest writers in the medical blogosphere.   You can find her over at Pulsus where she offers commentary on an eclectic mix of medical goodness ranging from social media to the subtleties of patient interaction.  Really good stuff.  Check out The Internet and Delusional Thinking.  Beyond her blog, Linda’s Twitter output is the perfect balance of valuable links and dialog.  Put her in your feed and she’ll bring you good things.

Chris Porter.  Chris is a surgeon who has been writing at On Surgery, Etc. since April.  This guy has an incredible voice and offers rare insight into the experience of the surgeon.  He has a remarkable way of seeing medicine at its most granular level.  When he corrals his narrative in just the right way I expect we may see him on the new release table at Barnes & Noble.  Check out his experience as a surgeon in Guatemala.  And from the narrow column Blogger template to the liberal use of crazy images, his site offers the raw feel of some of the vintage medical bloggers.  His bio reflects the mindset of a next-gen physician: I’m Phoenix-based and world oriented.  How can you resist that?

Aaron Stupple.  If I were a medical student I’d be thinking like Aaron.  He writes at The Adjacent Possible where he drills down on some of the pressing issues at the interface of medicine and technology.  He’ll help you think about the where the next generation sees themselves heading.  And if this makes any sense, he writes in a way that I like to read. Of course, he had me at The Adjacent Possible, a concept popularized in Steven B Johnson’s book, Where Good Ideas Come From.  Apparently Aaron and I think alike. While he’s only been at it since late 2010 I’m interested to see where he takes this.

Jin Packard.  Jin Packard at Fresh White Coat is another real voice representing the future of our profession.  He’s been at it since late 2010 and brings together a collection of material reflective of someone thinking ahead of the curve.  He’s even been courageous enough to try to bring his medical school to task on its social media presence. If you ever find yourself discouraged with the future of the medical profession, read Jin.  And I love his site design. On Twitter he’s @JinPack.

Franz Weisbauer/Lukas Zinnagl.  These guys write at Medcrunch. They kicked in late last year with the goal of  ‘creating a new kind of online magazine, that deals with topics that you won’t find in the NEJM or The Lancet – topics that will change the way you view the practice of medicine.’ I have to admit that every post I read makes me say, ‘why didn’t I think of that?’  Check out Signal vs Noise in Patient Care.  Follow them on Twitter @MedCrunch.

I’m always looking for fresh, new voices.  Who else should I read?

 

You’ve got to excuse me.  I’ve got this thing with Twitter disclaimers.  I think we’re like lemmings in the way we copy snippets of blind reassurance into our bios.  I’ve suggested that the 911 blog disclaimer is a practical joke initiated by the legal community.

‘These tweets are my own,’ is the workhorse of disclaimers but I wonder what purpose it serves.  What’s interesting to me is that we rarely see similar disclaimers used in other forms of communication.  When I spoke at AGA last week I failed to begin with a slide reminding the audience that my comments were not the official position of Texas Children’s Hospital or Baylor College of Medicine.  At cocktail parties we don’t use ‘pre small talk’ qualifiers that identify us as non-spokespersons of our employers.  What reasonable person would really believe that my Twitter feed is the official feed for the delivery of my hospital’s public opinion?

And do we really need to announce that our shared links don’t represent endorsement?  Who in the free world really thinks that when I retweet a link or idea I’m formally endorsing the site on the receiving end?  When was the last time a shared link lead to identifiable damages from the lack of the endorsement disclaimer?

I can understand disclaimers about medical advice.  But we’re all waiting for that first big judgment against the ‘disclaimerless’ doctor brought to her knees by that loose tweet construed by the patient-victim as individual medical advice.  Rest assured that when it happens you’ll hear it here first.

Ultimately I think this use of language is about fear.  But I suspect that those interested in getting at us won’t be deterred by cut-and-paste disclaimers.  Perhaps it’s time to rethink the practical utility of the disclaimer.

 

Yes, I know.  The title conjures up images of schmaltzy business self-help books with happy stock photo models adorning the cover.

But this idea doesn’t need a book, just a few hundred words.

I haven’t met a doctor who didn’t have concerns about the time commitment that social media potentially demands.  So I tell doctors that they need a social media budget.  Limit your properties and limit your time.  You, after all, have limited space to think about this stuff.

If you’re into marketing yourself, 30 minutes a day will give you market advantage.  If you are passionate about sharing information with your patients, a half-hour will do the trick.

So here are 5 ideas that won’t hog your human bandwidth. Pick a couple, use them and be happy.

Follow 50.  Pick 25, 50 or 100 really smart people on Twitter and follow them.  Peek at it a once or twice a day.  Be selective about what you listen to and share back in a way that’s meaningful.  Grow as your time allows.  Follow and unfollow ruthlessly to get the human signal you want.

Make a Cinchcast.  A lot of doctors have an easier time dictating than writing.  Cinch is a micropodcasting platform that allows you to record mini, under-5-minute recordings for public dissemination.  And they’ve got a great iPhone app.

Write a 250 word post.  You can maintain a very successful blog on 1-2 posts per week.  Pick one simple message for your colleagues or your patients and boil it down into a simple post just like this one.  What are you passionate about?  What do you want your patients to know?

Read 5 blogs.  Hand pick 5, or 3 or 10 of the best blogs on what it is that drives you.  Pull them into Google reader, Facebook or the RSS of your choice.  Read them, forget the rest and be happy.  Remember to comment on occasion.  This is how people will get to know you and this is how your expertise will add to the conversation.

Touch Facebook.  If you maintain a Facebook page for your practice, one solid post per day will carry you.  Think about what might bring real value to your patient population.  What’s the one link they need to read and why?  Just one good bit of really good information every day will earn you a reputation as a Trust Agent and build a following that will allow you to message in any way you see fit.

How would you leverage social media 30 minutes a day?

Graphic via Deziner Folio

 

I spend a lot of time and energy generating content for this blog.  But it wasn’t until recently that I started thinking about what would happen to my content if 33 charts was on the wrong end of a server error.  What if I was targeted by a hacker?  What if I lost it all?

So I hired Vaultpress.  VaultPress is a protection and backup service built on Automattic, the grid that serves nearly 14 million WordPress blogs.  It protects my content, plugins, dashboard, comments and all revisions in realtime.  And I can monitor all the vital stats of what’s happening under the hood.  My thinking ain’t goin’ anywhere.

I accessed support during my installation – very responsive but restricted to email at this point.

VaultPress is in beta so you can only get in with a Golden Ticket.  I suggest you get in line, especially if you’re unprotected.

If you’re serious about your content you need to be serious about keeping it safe.

 

As more doctors find their way into the world of social media, the issue of professional conduct will start to get more attention.

Here’s how I (try to) keep myself on the straight and narrow:

1.  I understand that I have boundaries.  I see my professional and personal spaces as very close.  So I recognize that I have to be really careful with what I say and do.  This is the first step towards responsible, professional online behavior.

2.  I remember that everyone’s watching.  Before I hit the publish button here on 33 charts I look at my post from the perspective of my academic division chief, chairman of pediatrics, colleagues worldwide, future employer, wife, etc.  I wonder what people would think and who might be offended.  I do push the limits on occasion but try to do it in a way that a thinking person would respect.  I think twice and publish once (usually).

3.  What would mama think. Parents trust me with their children.  This is a profound responsibility.  More than any other judge of my thinking, I’m most concerned with how I might potentially break the trust of a parent.

4.  I model myself after other social docs I respect.  I consider how I might be perceived by my peers.  The drive to earn and keep the respect of others helps keep me on the straight and narrow.

5.  I don’t drink and Tweet.  I never publish (microblog or macroblog) unless I can think straight.  And this applies when I’m upset or worked up.  I try to let more hard-edged commentary cure overnight.

6.  I define my professionalism.  While I need to formally create a page on 33 charts defining my personal policy of conduct, I’ve made it clear here and in a variety of public forums that I work to avoid dialog about patient care.  I frequently remind readers that I avoid political (very hard sometimes) and religious dialog that might offend the views of others.  I always try to be nice.

7.  I keep a dialog with my employer. I make it a habit to discuss professional conduct with my division chief at Baylor College of Medicine, Baylor risk management attorneys, Texas Children’s Hospital marketing execs as well as the Texas Children’s Hospital Compliance Officer.  I invite them to read and audit what I do so that they’re comfortable with what goes on here.  This shows that I take this responsibility of public dialog seriously.

8.  I listen to the response of my dialog.  While I’ve removed only a couple of posts since I began blogging in 2006, I have deleted tweets and reworked sentences after the fact.  The responsibility for my messaging continues after I have hit the publish button.  My community has been good about helping me understand if something is insensitive or poorly stated.

I’m learning this as I go.  How do you police yourself in the public social spaces to stay safe as a physician or professional?  What else can I do?

 

Phil Baumann wrote this week on the importance of attribution.  He describes the creeping trend of healthcare bloggers to avoid attribution and outbound links.

I’m a good example.  And for good reason.  I make every effort to link as little as possible and only where absolutely necessary.  Contrarian, you say?  Perhaps.

For years the social media gurus have propogated what’s known as ‘link love.’  Link love is about how we improve our standing with other bloggers.  It’s about how we can look good, get traffic, and ‘remind’ other people that we’re boosting them up so that we can have the ultimate social reward of being boosted ourselves.

For too long the blogosphere has been self-absorbed with little regard for the reader.  Bloggers ruminate over metrics, SEO terms, cross-linking, blogrolls, where their blinking ads are placed and other things that have little to do with anything but themselves.

Bloggers instead should obsess about the experience of their readers.

And when it comes to links the intent is what’s important.

Links have their place when they serve the needs and interests of the reader, not the social currency of the writer.  I add links when my idea or concept can be attributed primarily to one person.  I link when the outbound content is so remarkable that it will add to the reader’s experience.

This experience we create for our readers speaks for how we respect their time.  And links created with the intent of selling ourselves should be seen as piece of blogging’s narcissistic past.

 

More and more you hear about hospitals and organizations wanting doctors to blog.  Everybody wants content.

Sometimes the intent is to educate consumers, other times it serves the interests of a marketing campaign.

But good messaging is hard work.  Asking people to communicate in their free time disrespects both the messenger and the message they are trying to deliver.  And patient care is back-breaking work.  The production of creative content requires time, space and the creative capacity to think.

Patient care and content creation are consequently very, very difficult to juggle.

This is unfortunate because doctors and other providers have remarkable insight that could and should be shared.  I work with some 300 pediatricians in the north Houston area and I know that many have within them the most remarkable stories and knowledge that could be brought to life in video, audio or text.  I can imagine how the health infosphere would be different if they could stake their claim.

But for now, communication with the reading public just doesn’t pay.  If you want to volunteer, that’s great.  Otherwise, keep it to yourself and get back to work.  You’ve got three rooms waiting.

I can picture a time when those physicians with gifted voices are identified and given the opportunity to share and create within the context of their job descriptions.

 

My beef with social health is that most who take part spend most of their time speaking only with one another.  Last year at Blog World Expo during dinner with a group of health bloggers I sheepishly confessed that I had sneaked out of the health track to hear Steve Rubel speak.  None of them had ever heard of Steve Rubel.  And after hearing who he was they couldn’t understand what I could learn from him.

This is unfortunate.  Innovation in health will come from outside the health silo.  Many of the problems we face as physicians, patients and health administrators have been tackled in the financial and consumer industry, for example.  Operating rooms have even learned efficiency from the Formula One Pit Crew.

Today at the Blog World Expo Social Health Track we are reaching outside the silo with the help of speakers like David Armano and Frank Eliason.  I might suggest that in the future the dialog surrounding social health involve social media thought leaders from other verticals.  This is how we will grow.  There’s evidence of change at this year’s meeting but we have a long way to go.

Thanks our sponsors at Blog World Expo Social Health track:  Johnson & Johnson, MedPage Today, Wego, and Alliance Health Network.

 

Last night Susannah Fox put up the Bat Signal.  It seems she’s been charged with addressing the American College of Surgeons next month and she’s looking for some creative input from the medical social community.  Not surprising, really.  Interest in social media among physician groups is growing fast.

I thought it might be worth sharing a few random thoughts on the care and handling of the physician audience.

Doctors think in 1.0

Remember that the average physician is naïve when it comes to social media and its role in health.  Most physicians see e-patients strictly as consumers.  The concept of true socialization and active involvement by patients and physicians will likely be foreign to your audience.

With that said, you’ll get more mileage with a thorough, basic discussion of what this is all about and why it will change healthcare more than you will with a detailed how-to-do-it dialog.

A doctor is a doctor

Don’t sweat the audience.  While you could probably come up with some tailored, specific examples for surgeons or OBs, the core social issues for physicians are not specialty-specific at the introductory level.  In social terms, a doctor’s a doctor.

Raise your expectations

Based on their anemic adoption we sometimes think that doctors are resistant to the idea of social media.   I remember speaking this summer to one of the local medical societies in West Texas.  The audience was much older than I had expected and as I waited I prepared myself for resistance to what I had to say.  But, in fact, the opposite happened.  This audience of older generation physicians saw social as a way to potentially bring medicine back to its focus on connecting with patients.  Who knew?

Even if slow to adopt, physicians are intrigued and increasingly interested in social media’s potential.  We’re a malleable group.

Manage their expectations

It should be understood that we haven’t figured out where and how doctors should make social work for them.  Let’s face it, it’s time consuming and the applications that measurably impact care are few and far between.  The power lies in the potential that comes once we have the entire physician population in the loop.

And be careful of selling the fantasy:  While it makes great fodder for the media, selling “live tweets from the OR” as the saving grace of the next medical generation won’t win over any physician audience.

What keeps doctors up at night

As you think about your physician audience, consider why none of them have blogs or are found on Twitter:  1) Physicians naturally have issues with transparency 2) they haven’t got time and 3) they have concerns over liability and privacy.

But transparency is generational.  Time you can’t fix.  And issues surrounding patient engagement in the public forum are educational.

This patient contact issue and the theoretical potential for liability is a huge preoccupation.  I’ve found that a lot of physicians believe that their social entree obligates them to discuss patient issues in public.  I always convey my bias (possibly a slowly evolving standard):  discussion of patient-specific issues in public forums is off limits; discussion of patient non-specific issues is encouraged. Any attempt at patient-initiated discussion of specific medical issues immediately goes offline and onto the EMR for issues of record, liability and safety.

Doctor-patient dialog surrounding individual care should be limited to HIPAA compliant networks that integrate with the EMR.  I like to cite HelloHealth as an early example of this model.  The screen grabs always wow the crowd.

And if you can discuss an ethical dilemma or two you’ll have the academic elements of your audience drooling.  Bring towels.

Physicians have an obligation to be in the online space

Maybe I get away with it because I wear a stethoscope, but I always tell doctors that they have an obligation to participate in the dialog.  I always use autism and vaccines as the example.  The search engines in this regard are ruled by a loud, vocal minority linking vaccines and autism.  Consider that the American Academy of Pediatrics has 60,000 pediatricians.  If each of them were involved in the creation of some kind of content with reliable information, we would rule the search enginges.  Powerful stuff.  Always has an impact.

Think mobile

It’s estimated that some 81% of physicians will own a smart phone next year and mobile may be the segue into soft social adoption for many MDs.  Touch mobile and win your physician audience.

Tweet by example

One of the most powerful take home messages I pass to physician audiences is to study other doctors who are in the space.  Spend time watching and listening before taking the leap into the public forum.  I encourage people to look at what other doctors are doing and see how it applies to their setting.

Remind them to cultivate their digital footprint

I look at my role with physician audiences as one where I seek to motivate and empower.  And that’s when I feel rewarded. The idea that they can potentially control their digital footprint has huge value.  Ask the audience to do a vanity search and remind them that their reputation is under the control of sites like Healthgrades.  Remind them that they themselves are actually in control what people see when they are searched.

I encourage them to get started with a LinkedIn profile for one thing.  It’s soft social and a nice entrée into an online identity.

I’m not Joe MD

In a strange way I have to warn you to be careful of my advice.  Docs like myself and Howard Luks and others see the world through a very different lens than the average internist or general surgeon in middle America (who I refer to as Joe MD).  When thinking about our approach to the digitally naive physician we have to be careful about how we apply what we know about those of us who have already arrived.  Keep it basic and remember where they’re at.

Finally, I should say that Susannah Fox’s willingness to reach out to the physician community is a testimony to her understanding of how this social stuff is all supposed to work.  Even when we don’t know exactly how to approach something, there’s always someone who does.

I could go on all day.  What else would you add?