It’s reaching a point where the absence of real information on a doctor is considered creepy. Or, as Bunny suggests, useless.
This video I Forgot My Phone has created a stir. It plays on the idea that technology has pulled us from the realities of daily life.
This sentiment has become the fodder of popular writers who wax poetic about the days when we were free. When we’re disconnected, we’re light, real and human. We we’re connected, it seems, we are chained down and miserable.
Perhaps we should find a way to use technology that doesn’t make us miserable.
For starts, we might find a way to shape a balanced relationship with the technology we adopt. Balance must be effective on a daily, hourly and minute-to-minute basis. Our perspective on social tools needs a steady solution, not one controlled by a pressure valve.
Sure I feel a type of freedom when I’m away from my networks. But I feel a different freedom when I’m engaged with my communities. The two aren’t mutually exclusive. Both are key parts of my daily existence.
And real unplugging is increasingly impossible. The line separating our online and IRL lives is becoming harder to define. None of this is put together by anyone better than Nathan Jurgenson. He delivers hard reality to the tired belief that we’re all alone together. As he suggests, we fetishize IRL.
Technology is not to blame for our need to run, hide, unplug or disconnect. We’re to blame. We create our own noise, distractions and diversions.
Every doctor has a brand. But when I mention this, people throw things at me. Because everybody knows a brand is for potato chips and toilet paper.
This has nothing do with promotion or commercials.
Your brand is what people think about you. It’s what comes to mind when your name is mentioned. It’s a tattoo on the brain that’s been created by your clinical deeds and actions.
- He’s the surgeon who answers within 30 seconds of being paged.
- She’s the ID doctor who’s dress is as impeccable as her penmanship.
- He’s the vascular surgeon known for his rough bedside manner and compulsive attention to operative detail.
- She’s the softspoken pediatrician who takes lots of time no matter how far behind she is.
Even that quirky anatomy professor with the 7 dry erase markers has a brand.
Now enter the age of democratized media where every doctor with a smart phone is a publisher. Our public persona reinforces, or even shapes, our identity. Tell me that Wendy Swanson, ZDoggMD don’t have brands. Wendy is defined by her passion, energy, voice and transparency. ZDoggMD is defined by his unique delivery of health information.
Sure you can portray yourself in any way you like. But doctors don’t need to sell or pitch anything to have a brand. All they have to do is show up. Their patients and peers watching will do the rest.
JAMA last week published a nice viewpoint piece, Social Media and Physicians’ Identity Crisis, written by Margaret Chisolm and her peers at Johns Hopkins. The piece challenges the dated concept of multiple online identities. You can read their ideas here (but you’ll have to chisel through JAMA’s paywall).
While practically minded public physicians have long recognized that our personal and professional identities cannot be kept separate, the piece is critical in validating the idea among academic consumers.
To the best of my understanding, the concept of ‘dual citizenship’ began a couple of years back in the peer-reviewed literature. The concept is theoretically clean and, more importantly, it carries a certain appeal to those who don’t understand social media and digital culture. The idea of dual citizenship became popularized and it has subsequently been repurposed in policy statements and educational material.
For those who orchestrate and oversee policies and have never used these tools, their only point of reference is mainstream medical literature. And until very recently, solid thinking surrounding the physician’s emerging public presence has been poorly represented in traditional journals.
This is what makes Chisolm’s perspective piece important. It illustrates how our experience in public spaces need to be translated for traditional academic audiences. There are many things that we know from the past few years using social tools. In fact, we take many of these basic ideas and concepts for granted. But these concepts have never been formally documented. This represents a huge opportunity for physicians who are active participants in this emerging public space.
While the ideas and concepts written on 33 charts and other blogs have had the force to change a lot of minds, the mainstream medical literature remains important in reaching the sizeable audience that can’t see beyond the boundary of a glossy journal.
Recently Richard Smith, editor of the BMJ, called out the NEJM for failing to publish critical letters. His post in the BMJ blog network calls out NEJM as elitist. If electronic space is unlimited, he asks, why limit letters?
Good point. Buy why assume that conversation is controlled by the NEJM?
This is a great illustration of what I have come to call medicine’s culture of permission.
As physicians we’ve been raised to seek approval before approaching the microphone. For the hundreds of years you could only say something if someone gave you permission. It used to be that the only place we could share ideas was in a medical journal or from the podium of a national meeting. Our ideas were were required to pass through someone’s filter.
The angry scientists cited by Smith are of a generation when someone else decided if their ideas were worthy of discussion. They are a generation trained to contain what they think and believe. They are the medical generation of information isolation. Our culture of permission has bred a generation of obsequious followers.
In Poke the Box, Seth Godin calls this the tyranny of the picked: Waiting and hoping “acknowledges the power of the system and passes responsibility to someone else to initiate.”
This is unfortunate. When I think about my peers, I think about the remarkable mindshare that exists. Each is unique and brilliant in the way they think and see the world. Each sees disease and the human condition differently. They carry stories and experiences that can ease minds and save lives. But their brilliance and wisdom is stored away deep inside. They are human silos of unique experience and perspective.
But the way the world communicates and creates ideas is changing. The barrier to publish is effectively non-existent. The democratization of media has given every physician and scientist a platform to the world. But somehow we still believe that NEJM is running the show.
Going forward, the conversion of medical information into knowledge and knowledge into wisdom can only happen in a culture of participation. In the emerging networked world, we are all individuals endowed with unique skills, abilities and gifts. The unique mindsets and views that define us will allow us to offer something that was never before available.
The assumption here is that the only place for dialog and publication is within the boundaries of a paywall-controlled platform. This ignores the way the world communicates and shares information.
The problem here is not the antiquated ways of the NEJM, but the dated, permission-based thinking of the medical public.
There are only two things on the web:
- Content. The stuff that we look at.
- Conversation. The the dialog that happens around the stuff we look at.
Consequently, there are only two things that you can do online:
- You make the stuff that people look at.
- You talk about the stuff that other people make.
I’m working on a big project here. This seems too simple. What am I missing?
I like to look beyond the confines of medicine in order to understand medicine. And I happen to follow a handful of sociologists who bring me things that get me there. Today I stumbled upon “Not This One”: Social Movements, the Attention Economy, and Microcelebrity Networked Activism by Zeynep Turfekci. The paper explores a new dynamic borne of the networked age: the microcelebrity.
(Unless you have masochistic tendencies or an advanced degree in sociology, I would not try to muscle through this one.)
The microcelebrity uses “affordances of social media to engage in presentation of their political and personal selves to garner public attention to their cause, usually through a combination of testimony, advocacy, and citizen journalism.” They leverage social networks to command attention, drive issues and, in turn, enjoy a certain privilege not afforded other individuals. Such a position was not achievable before the democratization of media. This is a new phenomenon.
There are corollaries to the world I watch. Medicine and health is beginning to spawn its own core of microcelebrities. Many are connected in such a way as to wield significant power and attention. While most physician figures have not seized their positions for significant social or policy change, e-patient microcelebs have been successful as drivers of movements.
The pathway to physician influence was once achieved by scaling the ivy wall and conquering the heavily filtered publication matrix. Medical leadership in the networked age will be determined increasingly by trust, access and the attention of the professional public.
h/t to @nathanjurgenson for the Turfekci paper.
Institutions are looking for rules to govern how doctors should behave using public digital media. When I’m asked about rules I usually suggest that we start by referencing the standard manual of physician behavior. That, of course, gives us a nice place to start.
But certainly there are agreed upon guidelines that direct a physician’s conduct with everyday situations? There must be rules that guide the handling of patients who approach us in the grocery store? If I remember correctly the Federation of State Medical Boards issued specific, bulleted recommendations on how a physician should interact with patients who they know in their church or synagogue. And there must be specific guidelines on the appearance of alcohol consumption in public. Inappropriate communication with patients using the telephone or U.S. Postal Service has been addressed with firm consensus by the AMA, I’m sure.
The specific rules of countless day-to-day situations were never before spelled out in guidelines and policies. The subtleties of our conduct and reactions to situations were shaped by modeling, personal judgment and the standards of our respective communities.
We used to be smart. Or at least we gave physicians more credit. We understood that some things are better left to communities rather than regulatory bodies.
I looked for formal, published guidance on how I should behave. This 1927 essay from the Bulletin of the New York Academy of Medicine was all I could find.