Dozing Doctors and Digitally Mediated Whining

Sleepy (1)Buzzfeed has profiled a group of medical residents who have published pictures of themselves asleep.

It’s fascinating, really. More of a phenomenon than a movement. There appears to be no unifying message, organization, or call to action. Rather a soft, civilly disobedient show-of-force fueled by social contagion and the need to be heard. A pig-pile of digitally mediated whining.

Like all trainees, we fancy ourselves as victims. While I can’t attest to the training standards of any of these individuals, I’d be more impressed if I thought any of these youngsters were actually asleep.

If nothing else, it’s artificially colored red meat for those who think that the way to train a doctor is to minimize the time spent with patients.

When Doctors Write About Patients

b020149Anna Reisman’s Atlantic Health piece, Should Doctors Write About Patients, has received lots of dialog.

Writing about patients is not new. What’s new is the capacity of every doctor to build an audience and write about patients. Publishing has become democratized.  From constrained micromedia to traditional long-form, every doctor has the means of sharing their experiences. This is great. But it creates potential issues as doctors learn to manage the boundaries of public dialog.

While my colleagues who teach this craft likely have a more nuanced approach to the issue, I see the issue of writing about patients as relatively straightforward.  Any identifiable patient experience intended for the public space needs the patient’s consent.  Otherwise, our experiences must be altered such that they can’t be identified.  Unless it’s a patient’s wish to have his story disclosed, the reality is that many of our most powerful experiences will remain nothing more than our own.

I’ve found that much of the discussion around physician narratives involves what the law allows.  And for good reason. But there’s privacy as it relates to federal law and there’s privacy as it relates to the bond we share with those under our care. We should see our obligation to patients as something higher than that mandated by legislators. This often gets lost.

The discussion often gravitates to the doctor’s desire to share.  The doctor-as-artist looking to translate her experience for general consumption is positioned as a gift.  We hear the merits of the doctor’s POV — the educational value for physician trainees and even patients. And for good reason as there is so much we can offer.  But at the end of the day, what we want or what we can lend may be less relevant.  We’re bystanders in the patient’s world.  We exist to serve their needs.  This makes our position in the relationship we share a tortured space for those called to write.

As more physicians put their hands to the keyboard and enter the public space, this subject needs ongoing discussion and tighter integration in undergraduate medical education. Thanks to Anna Reisman for getting the ball rolling.

William Osler | National Library of Medicine

Social Media Has Been Introduced to Physicians

There’s a national organization that I’ve done some work with.  And for the past few years I have run social media sessions at their annual meeting.  Social Media 101 and other programs with non-threatening names intended to draw in frightened doctors.

This year I suggested that the days of the new thing have passed.

At some point we must go beyond the introduction and  into application.  The leadership of physician organizations need to begin to pay attention to the adopters and what they can do to move the needle.  Repeatedly pitching the terminally skeptical doesn’t work.  Tired arguments about the dangers of communication will never be won.  While newbie public physicians need to be educated, there are great resources available for doctors new to the public realm.

We’ve reached a point where social media is now part of the professional workflow.  While it’s a minority that understand and leverage these tools, the ones who are onboard are helping reshape the image of our organizations and our profession.  Those of us creating, curating and conversing in the great wide open will continue to benefit from our public presence.

And what about those looking to join us? The genuinely curious and motivated will figure it out just like we did.

Weekend Medicine

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It’s remarkable that hospitals still keep weekend schedules.  On the weekend, things stop.  They don’t stop, but they really do.  ORs operate with emergency staffing.  Routine diagnostic imaging is held until Monday morning.

Weekend schedules are a throwback to a time when the tempo of health care was set by the doctor’s rounds and the hands of a clock.  The doctor was out, then he came in.  He’s off for the weekend; she’s covering.  It’s after 5. Weekend medicine is as much a mindset as it is a model of care at an analog pace.

As medicine is consumed by technology and the measurement-diagnosis-response sequence happens closer to real-time, the on/off dichotomy of weekend medicine will be unsustainable.  For patients, it’s already worn out its welcome, but they don’t have much say in the matter.

Mindsets and models are evolving fast.  Stay tuned.

Image via Flickr

How a Doctor Can Improve His Digital Footprint in One Hour

Doctor’s are almost universally concerned with how they appear online.  And almost universally, few have the time to invest in content creation, curation and conversation.  At a minimum physicians should be building out their public facing profiles.  Claiming these profiles represents a quick and reliable way to control an important piece of the digital landscape.

While writing, taping and creating represents the best way to build an online presence, profiles are a quick way to get out of the gates.

This voiceover format is something new for me.  I’d love to know what you think.  

9 Secrets for Making the Most of Your Doximity Profile


33 charts is excited to have Doximity as our featured sponsor this week.

Frustratingly, much of what appears about physicians online is out of our control. There are only a few places that give doctors power over their social presence. With nearly 50% of all U.S. physicians as members, Doximity has emerged as the core professional profile for doctors and one that’s totally within physician control. It’s the first place I go to update my professional status as it changes.

While you may already be a member, do you know how to make the most of your Doximity account?  Here are nine pro tips to help you make the most of your Doximity physician profile:

1. Let Doximity scour the web for you

Patients and professionals never stop searching for information on physicians online. Your public facing professional profile represents a 24/7 representation of who you are and what you’ve accomplished.  While keeping everything updated can represent a big challenge for all of us in medicine, Doximity does the heavy lifting.  The professional network scans the Web for the latest information on publications, awards, and speaking engagements related to your professional CV.  The average physician’s profile receives 30 automatic data updates each year from Doximity.  If you’ve been away from your Doximity profile for a while, log in and check it out.

2. Take a top-secret shortcut

It’s not publicized, but Doximity will upload your CV information for you. Just send over your most recent resume to and their crackerjack team of CV elves will do all the work. The average curriculum vitae received by Doximity is 21 pages long—that’s a lot of typing you get to skip. Since about 85% of Doximity profiles appear on the first page of a Google name search, you should maximize the chances that your hard work gets connected to your name.

3. Add “clinical interests” to make your profile more interesting

You should list your clinical interests in your Doximity profile. Just start typing and Doximity will provide you an intelligent list of commonly selected clinical subjects. Here’s why these interests are important: They allow more targeted outreach for referrals and better news curation with Doximity’s DocNews delivery.

4. Claim your very own custom URL

Click “Edit” on your Doximity profile and you’ll see a section to claim a custom link at the top. You can shorten your link and optimize it for your own expertise.  Include your Doximity profile link in your email signature, on other social media profiles and in your bio when you speak/publish to boost the quality of your professional presence online. Your Doximity profile should represent who you are and what you’re about. This link offers a simple, consolidated connection to that information.

5. Get recognized by U.S. News & World Report

Did you know that your U.S. News & World Report physician profile automatically refreshes anytime an update is made to your Doximity CV? The two companies have a partnership where Doximity physician data instantly transfers to the U.S. News Doctor Finder service. If you don’t take advantage of this you’re just crazy.

6. A picture is worth a thousand clicks

A quality headshot has become a key element in every online profile. Make a good first impression by choosing a headshot that’s clear, professional and high-resolution. Your headshot should probably be updated at least every two years. While Doximity will find and suggest photos to match your profile automatically, uploading your own is a best practice. Doximity profiles with photos appear first in search results and get more interest than those without pictures.

7. Make yourself automatically available to new job opportunities

There are over 175,000 job offers sent to physicians each year on Doximity. Get matched with the best jobs by indicating your salary and career preferences in the Doximity “careers” section. You can select specific areas where you want to work (Hawaii!) and can choose between full-time, part-time and locum tenens. Each opportunity is highly targeted, with physicians only receiving a handful of offers specifically matched to their CV each year. Plus, recruiters are required to provide a salary range with each job message.

8. Make a speech

Doximity alerts you when your work is being discussed in online physician conversations. Plus, you can expand the reach of your content by adding a presentation to your Doximity profile. Any PDF, PowerPoint or Word file can be embedded in your CV. You might upload slides recently presented at a medical conference or share a preview of the first chapter of your upcoming book with colleagues. Do you have even more to share? Post your Twitter feed, blog, video clips, kickstarter campaigns or any other social sites in the “Links” section at the bottom of your profile.

9. Your Doximity profile works for you—keep it updated

After you’ve updated the information on your Doximity profile, turn your attention to establishing your professional network. Doximity members have an average of 53 professional connections on the network—can you do better? Connect with alumni from medical school and residency training. Reach out to your referral network on the platform. Set Doximity to share your direct contact information within your private network and you’ll be amazed at how quickly new opportunities start to arrive from colleagues.

While LinkedIn once served as home base for my bio and critical information online, Doximity now serves as my core presence online.  You can check out how I’ve shaped my bio.  You’ll also notice reference to an editorial published in this month’s journal, Pediatrics.  That citation populated by itself right onto my profile.  Check it out and then let me know how you’ve shaped your Doximity profile.

Doctors and the Private-Professional Divide

imgres-1Video and communications expert Drew Keller spoke this afternoon at the 6th Annual Health Care Social Media Summit at the Mayo Clinic. He described the experience of working with doctors and suggested that they have two modes of communication: private and professional.

In private, and with patients, they have natural, easy ways of using language, expression, and metaphor to explain conditions.  But in front of a camera or onstage they become quite public in their behavior. Given concerns with the permanence of media and the potential for peer and public judgment, they behave and communicate differently. They’re tighter, more calculated, and even guarded in the way they appear and deliver. As a result, they appear less human and less believable.

I suspect that the ability to comfortably bridge this private and professional divide represents the sign of a great communicator. Few doctors can do this, or they’ve not had the coaching to facilitate the connection. While Keller was referring to video performance, writing could just as easily be considered subject to this private-professional divide.

As media of all type bring doctors from medicine’s private, silo’d mode into the public realm, I suspect skill in bridging this gap will be critical for professional survival. Call it a translational communication skill, or better, letting our guard down, relaxing and being real.

You can follow more of the meeting at #mayoragan

The Rise of Medicine’s Creative Class

LightbulbAre we witnessing the rise of a creative class in medicine?

The creative class in medicine may be seen as a key driving force for change in a post-analog era.  They are the disruptors willing to poke the box.  The reason that this emerging segment of health care providers is so remarkable is that medicine typically punishes creativity.  In medicine, makers make at significant professional risk.

The creative class in medicine is facilitated by the democratized tools for writing, recording, photographing, making and publishing.  Anyone with an internet connection and a good idea can have a talk show.  Everywhere I turn I see docs making things.  This weekend Joyce Lee collected a bunch of makers and tinkerers at the University of Michigan for We Make Health Fest.  FOAM has evolved beyond a global movement to a mindset about education.  Digital provocateur Larry Chu and the thinkers at Stanford’s Medicine X have driven a new conversation about patients and medicine.  Look under the hood and you’ll see that Medicine X is driven by medicine’s creative class.

Quite predictably, not everyone likes it.  All this free thinking, sharing, making, and generalized lack of lockstep order makes some of us just a little bit uncomfortable.  But uncomfortable is good.  We all need to get a lot more uncomfortable.  We don’t have a choice.

It’s no longer 1954.  But there’s an unexplainable high to seeing 400 years of a stagnant profession turned over like rotting compost. With that said, I suspect that somewhere William Osler is smiling.

Ayn Rand had words that I’m sure were intended for those members of medicine’s creative class intent on drawing the map for the next generation of medicine, “The question isn’t who is going to let me, it’s who is going to stop me?

Doctors and social media: Damned if you engage, damned if you don’t

Like symbol on white backgroundHinda Mandell felt creepy after being followed by her OB on Twitter.  Her post on Cognoscenti, Brave New World: Your Doctor, Your Private Parts, Twitter And You, is provocative on a number of levels.

Think perverts, not OBs.  It’s funny that the author’s friends and husband are concerned with her OB.  There’s little regard, however, for that serial pervert in a dimly lit room enjoying her recently shared images.

(That troubling little scenario puts things in perspective)

‘Following’ is irrelevant.  Your conversations are likely visible to every member of the planet whether or not you are followed.  Your comments are publications.  So if you’re uncomfortable with your ideas and images being seen, don’t publish them.  Or think about what you’re publishing.

Engagement is relevant.  What’s done with regard to engagement between a doctor and patient is what’s important.  Any social encounter has the potential to cross the line.  This isn’t specific to social media, however.  If you don’t like what a doctor does in the office, at the bedside, at a PTA meeting, on the phone, in church, or on Facebook, vote with your feet….or your mouse.  Relationships go both ways.  By assuming we have no control we make ourselves victims of our own visibility.

Damned if you engage, damned if you don’t.  One e-patient wants engagement, the other thinks it’s creepy.  No wonder doctors are confused when it comes to their public voice.  Let’s just face the fact that every social relationship is different and those participating need and want different things.  Policies at checkout windows will never fix that.

If you want a delineation of what I’ll do on every social platform, be prepared to wait.  I’m not sure if I follow any patients at this point but I suspect I will never have a Twitter policy on who, when and why I follow.  If, for example, a parent happens to run a blog, company, or organization that deals with technology and medicine, it might be something that I’m interested in.  I have plenty of patients who run non-profits for their children and associated diseases.  I might want to support these patients.  I won’t rope myself into a written policy because someone’s husband chooses to puff his chest out.

Committees are unlikely to legislate social engagement.  Just as there are no AMA guidelines on how I should deal with a mother who approaches me at a cross-country meet, there will likely never be actionable and practical guidelines that direct doctors to the seemingly limitless situations we face in the public space.

I could come up with another 20 points.  Where have I gone wrong?

h/t to Greg Matthews for pulling this story into my feed. 

Just found an excellent post on this story over at the Mayo Clinic by @LeeAase

Social Media: Managing Expectations with Doctors

iStock_000016431625SmallI frequently speak to doctors about social media and the management of their public presence.  There are 4 listeners who show up to my talks:

  1. The doctor who isn’t convinced social media is worth thinking about.
  2. The doctor who’s convinced it’s important but wants to know specifically how and where to get started.
  3. The doctor who’s started but needs help understanding how to apply these tools as a provider.
  4. The doctor who comfortably uses social media as a provider but wants to be a power-user.

Each group wants something different.

Some meeting planners don’t understand that these 4 audience members exist.  And when you tell them, they typically request ‘something for everyone.’  But when you try to please all 4 listeners, you risk that no one will come away with anything.

I find it helpful to manage expectations up front with both meeting planners and audiences.  With planners you may have to inquire about the audience and make your best guess.  They may need help in understanding what might work best for a certain population.  The focus of your presentation should be reflected in the program materials.  At the outset of a talk, be sure to outline what you’re trying to do…and what you won’t.

Times are changing.  3 years ago all talks to physicians were centered on the first group.  Increasingly I find myself gravitating further down the list.

Does your next meeting need a keynote speaker on social media or the new, emerging role of the physician?

Can Google Help Us Choose Doctors?

imagesAnyone involved in medical education should read Thomas Friedman’s, How to Get a Job at Google.  Read the piece and think about what Google could teach us about choosing the next generation of physicians.

Google’s criteria are centered on five areas:

  1. Cognitive ability.  The ability to process on the fly.
  2. Leadership.  Emergent leadership as opposed to traditional leadership.
  3. Humility and ownership.  The ability to step back and embrace the ideas of others.
  4. Intellectual humility.  Because without humility you are unable to learn.
  5. Expertise.  Interestingly, the least important attribute at Google.

Medicine is changing quickly.  The Google lens might offer valuable insight in how we think about the attributes of physicians in the digital age.