The Public Progression of Physicians

5646822351_d8af810d49_z (1)When it comes to doctors and social media, the past few years have been occupied with how doctors can make the transition to public life. Our dialog has traditionally focused on digital immigrants – established physicians adjusting to life with new tools and a public voice. The discussion begins with the argument for why a physician should be there.

But another population gets little dialog: digital natives who come to medicine already engaged. They are our future colleagues comfortable with tools of public dialog but without a clue as to how to it should be used as a professional.

It’s remarkable. Students with no idea how to use social tools as professionals come to medical education under the supervision of teachers who have never used the tools themselves. Students leave medical school with, at best, token discussion of how to conduct themselves beyond the IRL space.

Yet communication, education, and translation of knowledge are at the core of what physicians do. Increasingly, this happens in the public realm. The failure to prepare physicians for the realities of our new social environment is a failure of medical education to keep up with the realities of physician life in a connected age.

I have found that young physician trainees go through a public progression as they transition from personal to professional use of democratized media. It’s a sequence of thinking about how they fit in to the broader discourse. It’s an early concept that I plan to expand. I would love feedback.

College – In the beginning, public media use is almost exclusively personal and social. More engagement-centered and less focused on content. The risk and impact of conversations is barely a concern. Students have little sense of accountability until the point when they realize they will apply to medical school. Public visibility is seen almost exclusively as a liability. Concern is with what their friends think.

Medical school – Students begin to realize that they are part of something bigger than themselves. Students begin to process the fact that their public presence must be balanced with responsibility to community and patients. They recognize that there are actual professional risks associated with public dialog. Students are too far away from professional practice to understand, grasp or be concerned with the opportunities that a digital footprint can afford. They begin to identify and deal with issues of patient boundaries, privacy and personal and professional identities online.

Residency – Aware of the implications of a screwy public profile, residents are more reserved with their outward presence. Some of this may be time/schedule limited. Public visibility begins to be recognized as an asset that can serve their professional needs.

Professional life – This is the culmination of the transition. Our public presence is more centered on our professional interests and passions. We’ve learned to balance our personal and professional identities and are comfortable with and around patients in conversation. Our concern with social tools is centered on what our peers and patients think. We recognize that tools can be used for education, advocacy, professional promotion and learning. What and how we do what we do in a networked world must also be integrated into continuing medical education (CME).

Thinking about the sequence and stages of public professional transition is important as we must deliver content in the context of where the trainee is at. Students must learn to mitigate risk early in their training. Students beginning their clinical training must understand the specific issues that they’ll face when in contact with patients. Residents must understand how social tools can be used for professional growth. Trained professionals must recognize how to specifically leverage these tools for their specialty and work situation.

We have approached this issue at Baylor College of Medicine with our Digital Smarts curriculum. It is an undergraduate program that takes students from orientation through to graduation with the delivery of material specific to the student’s context and stage of development. Exclusively case-based, the program is entering its third year and it represents the first and only curriculum of its kind.

I would love feedback on this concept of the physician public progression. I may be reached at bsv at bcm dot edu.

If you are interested in the evolving role of the physician in public, please download a free copy of my book, The Public Physician.  

[Image via phlubdr on Flickr]

How Do We Restore Joy to the Practice of Medicine?

Geneia_Infographic_jpgI see it every day. Physicians discouraged over the state of medicine feel that they are powerless over the forces changing health care. And it would appear that what I see represents a broader national trend. The results of a survey of over 400 full-time practicing physicians released this morning by Geneia show what physicians are thinking.  Here are a few of the most compelling stats:

  • 67% of  surveyed doctors know a physician who is likely to stop practicing medicine in the next five years, as the result of physician burnout.
  • 51% report they have considered career options outside of clinical practice.
  • 87% say that the “business and regulation of healthcare” has changed the practice of medicine for the worse.
  • Geneia’s nationwide Physician Misery Index is 3.7 out of 5, indicating that scales are tipping from satisfaction to misery for those in practice.

Physicians must seize the opportunity

But here’s another way to see it: Despite the numbers revealed by Geneia, I’m convinced that this is the most exciting time to be in medicine. Technology is advancing almost faster than our ability to keep up.  And everything about what it means to be a doctor is changing.

This, of course, spells opportunity.  From our capacity to globally share and publish our ideas to our ability to actually make new technology, we are moving from observers and followers to creators. The future doesn’t happen, it’s created.  All of us have the chance to make a mark and share in how things evolve for us and our patients.  And all of us should be active participants in reshaping the way we see our field.

Take the challenge

So I’m excited to announce Geneia The Joy of Medicine Challenge. The Geneia Joy of Medicine Challenge is an online competition to solicit ideas from U.S. licensed physicians on how to best restore the meaning behind the practice of medicine. Judging will be done by a panel of physician judges in combination with peer-sourced, online voting (Full disclosure: I’ll be spearheading the judging). The winner in each of three categories – the EHR of the Future, Population Health, and Joy of Medicine – will receive a $1,000 cash prize and one winner will receive in-kind Geneia consulting resources valued at $5,000 to help refine their idea.  The Challenge is being managed by Medstro, a social professional networking and career development community for physicians.

Entries will be accepted today through April 29, 2015.  So if you are a practicing physician, log in to Medstro and bring your ideas.  I’ll be checking in and commenting on ideas as they evolve.  If you want to bring your conversation to Twitter, use the #joyofmedicine hashtag.

Big kudos to Geneia for sponsoring and Medstro for hosting The Joy of Medicine Challenge.  This is a conversation that we need to have and I’m thrilled to be a part of it.  I hope to see everyone there.

100,000 Connected Lemmings

Streetart aus aufgeklebten grob verpixelten Figuren, die an das Computerspiel "Lemminge" erinnern.

Doctors come on to Twitter nearly every day.  Sharing ideas is now simple: Medium and LinkedIn have made ownership of blogs almost obsolete.  We’re all using these tools.

But none of it means anything unless you do something with them.  Sure we can pass along the flashy tweets about the latest smart diaper.  ‘Breaking’ news of the tattoo that detects cancer before it forms is easy.  And cheap.  But doctors with shiny tools are nothing more than 100,000 connected lemmings mindlessly passing along senseless information.  A digital bucket brigade.

The last few years have been about the shiny tools.  Now we’ve got to put those tools to work. Chicago cardiologist Wes Fisher recently used his tools to shine a garish light on the American Board of Internal Medicine.  Once started he found lots of helpers.  But he was brave enough to start something.  This is how our public presence can be used to change things.

Clay Shirky described our point of transition this way:

As with previous revolutions driven by technology—whether it is the rise of literate and scientific culture with the spread of the printing press or the economic and social globalization that followed the invention of the telegraph—what matters now is not the new capabilities we have, but how we turn those capabilities, both technical and social, into opportunities. | Cognitive Surplus, 2010

A voice is worthless unless you use it for good.  What are your tools?  What are your opportunities?

Image via Flickr

Social Health’s Sewer of Self-Interest

LikeThere’s an affirmation bias in public dialog.  We only like things.  Facebook, for example, only offers Like button.  To dislike is not PC.

Perhaps we can thank the marketers.  In social’s early history, we took our cues from marketing professionals who were the early adopters in the use of new media.  They’ve traditionally lead the conversation on conversation.  Marketers love to cheer.

Moving beyond cheerleading

But what marketers want and do may be entirely different from what healthcare professionals might and should do.  It’s not that we can’t promote, but maybe we have an equally important job that’s entirely foreign to the look and feel of our traditional dialog.

A couple of days back there was a story circulating on Twitter about a teddy bear that captures biometric information on cuddling children.  Predictably, everyone pushed the story along like a beach ball at a stadium event.  The future, it seemed, was just adorable.  Wendy Swanson spoke up and suggested that maybe there was more information needed before planting this in a child’s hospital bed.

We need to question things

Admittedly, it’s fun to share links about flying robotic bedpans that detect colon cancer.  But we desperately need to question things.  The social health infosphere is a sewer of self-interest.  And as the personal digital health heats up, someone will need to ask the tough questions and shape meaningful  dialog.

There aren’t enough physicians taking leadership in this role.  Of course it’s a tall order:

  • You must understand the tools and have some semblance of a voice.
  • You need the confidence and chutzpah to leverage that voice.

It’s a jungle out there.  Standing on your own two feet in an information stream that’s moving briskly in one direction can be tough.  We’re up agains powerful interests and well-connected microcelebrities.  And taking a public position opposite a peer takes a whole other level of confidence.

But for those looking to define themselves in a noisy world, defying our affirmation bias with a healthy element of skepticism is one way to not only stand out but create value.

How Twitter has Changed

Retro twitterOn a recent Stanford MedX Google Hangout I was asked how Twitter had changed since I began using it in 2008.

Initially it was relatively private and consisted of a patchwork of organic microconversations for those who chose to sign on.  It seemed to be more conversation than curation and sharing.  It felt edgy and raw in terms of subject matter.  The only people watching were the few who were participating.

Personally, I had few inhibitions with regard to what I shared.  I had never experienced public dialog in a near-synchronous way and the whole thing was fascinating.  It seems that I had to get my hands around it before I could understand what could be done with it.

At the time I had little understanding of social platforms as public arenas.  In fact, I had never considered the implications of participation.  I didn’t know there were any.  In fact, I didn’t think I was participating in anything.  Professionalism, permanence and the potential scale of off-colored remarks had never been raised as concerns since public dialog was something few physicians did.

Somewhere before 2010 everybody started looking and Twitter became public.   Then we started looking and acting like we were in public.  For me that’s when Twitter moved from a small, contained group of physician and patient friends to a publication tool.  We all diverged and began to use it in different and unique ways.

My personal evolution with Twitter has been just like my evolution with every other tool of public communication over the past eight years.  I start using it one way, then end up using it another way.

If you’ve been at it a little while, how have you seen Twitter change?

Image via the Moma agency.

LinkedIn as a Publishing Platform for Physicians

LinkedInToday LinkedIn expanded its publishing platform to allow users to create and share long form posts.  Before today, content creation had been a LinkedIn feature limited to a small number of LinkedIn influencers.  The launch of this feature will be limited to 25,000 users and rollout worldwide will take place over the coming two months.

Posts will appear as part of user profiles.

This is a huge development because it allows the average physician to have a space to create and share substantive thinking that previously had nowhere to live.  And that writing can exist tightly connected to a public profile that physicians are finding easy to adopt.

While a LinkedIn profile should be centered around a powerful biography, this new feature will allow more latitude in understanding what makes someone tick.  As much as what you’ve done, it’s powerful to see how you think.  Add this to feature to my recent thinking, 8 Ways a Doctor Can Become Public in Under an Hour.  It should represent a powerful way to boost your digital footprint and begin to tackle the beast of online reputation management.

While sites like Kevin MD remain excellent surrogate platforms for content creation, the new LinkedIn feature will represent an easy point-of-entry for the doctor  interested only in occasional posting.

I’ll follow up tomorrow with some other ideas brewing around this development.  You can read the LinkedIn release here.

Laughing at ZDoggMD

ZdoggmdI spend a lot of time addressing physician audiences.  It’s a pretty regular thing that I use Zubin Damania to showcase the individual physician voice.  He provides a great example of creative expression that leverages todays tools to change ideas about health.  He’s a core player in what I like to refer to as medicine’s emerging digital culture.

Universally there are folks in the audience who snicker and sneer when I display some representation of ZDogg’s stuff.  And not in a way that they are truly amused or inspired.

It’s infuriating while at once satisfying.

It’s infuriating to feel the subtle criticism of a physician who steps out to make, create, and change.

It’s satisfying in a way to know that these critics can’t understand any world beyond their immediate personal space.  They haven’t the capacity to participate, steer, shape or work using the tools that a networked medical world affords.  They wouldn’t know where to begin.  Their vision of the future is shaped through the accomplishments and workflows of a bygone generation.  When shown the future, they recognize their withering authority in a world no longer harnessed by a dusty, industrial-age hierarchy.  And I suspect their awkward insecurity stems from the realization of their impending irrelevance.

There are some who don’t seem to understand.  But their disconnect may be a good thing for medicine.  Perhaps we should keep it that way.

12 Things About Doximity You Probably Didn’t Know

We’re excited to have Doximity as our featured sponsor this week.  The ideas below, however, are conceived, shaped and written on my own.

PNG - Doximity IconIn a world where doctor’s are feeling the squeeze from all sides, Doximity is working to create a space that makes it easy for doctors to do what they do.  Having watched it evolve from the time of its launch, what’s impressed me is the consistent ability of the Doximity team to pivot and adjust their product depending upon the needs of its users.  What I saw 3 years ago is not what I find today.  And what I’ll see in 3 years will likely be something tested and tweaked for a new crop of digital physicians.

I wanted to do something a little different with this post, so I searched and handpicked a few Doximity facts that highlight its unique features and position.  Doximity is free for licensed physicians and medical students in the U.S.  Register and claim your profile if you haven’t yet.  It will help you make sense of the list.

1.  Doximity is as much platform as network.  While Doximity is often thought of as just a social network, it serves a variety of functions including rolodex, professional profile page, CME tool, email/fax/text service, news portal, and digital doctors lounge for curbsides and conversation.  It’s emerging as a platform for doctors to get things done.

2.  Doximity was founded by Jeff Tangney, co-founder of Epocrates.  Jeff knows doctors and he knows how to build the things they use.  This explains why he’s super-involved in the experience of the Doximity user.  He regularly takes email from Doximity users at jeff at doximity dot com (I’d recommend joining first).

3.  1 in 4 U.S. physicians is on Doximity.  And a recent survey by the American College of Physicians listed Doximity as a top 5 app most used by the members of ACP.

4.  Doximity is doctor-driven.  The majority of product decisions come from Doximity’s member groups – Medical Advisory Board, Fellows, Panelists & Ambassadors.  (For example, my input was instrumental in selection of the current ‘wifi d’ logo that you see up and to the right).  The co-founder of Doximity, Nate Gross, is a physician.

5.  You can earn CME credits like you’re eating potato chips.  I just started doing this and here’s my process: Read | Learn | hit button.  It’s like eating potato chips, only better for your brain. The program is powered by the Cleveland Clinic and supported by the content of a load of major journals.  Doximity will track your credits and, most impressively, they’ve hired elves to personally integrate your CME credits onto your Doximity transcript.  Email them at

6.  Doximity users love to fax.  One of the most frequently used Doximity features is its HIPAA compliant fax tool.  Since I’m not a fax user at all, this has always been a surprise to me.  As a registered Doximity user, you are assigned a lifetime fax number that allows you to send and receive secure fax messages between offices or to pharmacies.

7.  Physician profiles are public facing.  Many members don’t know this, but your profile is searchable and viewable to the public at your discretion.  Controlling your digital footprint is a new professional responsibility for doctors.  And if you don’t tell your story, someone else will.  All the more reason to have a complete and compelling profile.

8.  Adding a profile photo doubles the chances of someone finding you.  Doximity profiles with pictures get preferential search ranking.  So upload your mug and be found.

9.  Med students rule.  Doximity supports the next generation of physician from day one of medical school through their inclusion in the network.  Med students sign up just like doctors.  They’ve been a Doximity priority since their earliest days.

10.  Public content can convert to doctor-only dialog.  Sensitive to the fact that some docs are bashful about their commentary, Doximity has designed elements to pull dialog started in public into the professionally private realm.  On Twitter, for example, tag your tweet with #dox and your post will make its way into iRound, Doximity’s chatter stream.  They’ve got a nifty Doximity share button that, when punched, opens a comment box and then, when saved, pulls the link of that article along into Doximity iRounds.  If you go to the bottom of this post and hit the Doximity share button, you can see it in action.  For best effect, sign in to Doximity first.

11.  Doximity search is perhaps its most underutilize power-feature. This is helpful when looking for doctors of a particular breed.  For instance, if you needed a French speaking knee surgeon in Atlanta, you could type “ortho knee french Atlanta” and find that perfect referral.  I’m not kidding, try this.

12.  The co-founder of LinkedIn, Konstantin Guericke, sits on Doximity’s Advisory Board.  Tells you a little about where Doximity sees itself heading.

PNG - DoximityThere are lots of other interesting features to Doximity.  Check it out and find your own.  And if you’re not a member, you can claim your profile here.

So what key features of doximity did I forget?

Doctors, Social Media and Shiny Objects

shinyobjectMost presentations to physicians on social media don’t do the job that they should be doing.  They focus on the medium rather than what the medium can bring.  They focus on tools rather than the value offered by tools.  The audience only sees the shiny object.

Presentations that tell doctors about social media rarely motivate.  Few of us care about computer processors.  But everyone cares about what computers allow us to do.

Our focus should be on what a networked public presence can deliver to make our lives as professionals or the lives of our patients better.  Emphasize the power of a networked public presence, not the nifty tools that facilitate the presence.

(and by the way, these tools are no longer new)

Show them the value and they will come.

An Institution’s Responsibility to a Public Physician

RostrumWe talk a lot about the responsibility of doctors to respect a certain standard when it comes to their public presence.  I’ve suggested that we’re accountable to our communities, colleagues and our patients.  Extreme views and rogue behavior have a way of reflecting badly on those around us.

The question then becomes, what responsibility do institutions, colleagues and patients have to physicians with a voice?  Is there any level of acceptance that must occur once we realize that doctors no longer represent the stereotype that we’ve been used to?

While physicians must see their role in a larger organization, the larger organization must recognize the role of the physician in public.  This involves:

  • Respecting a physician’s individual right to express, build, create, curate, converse and advocate.  Doctor means ‘teacher.’
  • Embracing the unique brilliance of every physician voice with the understanding that it can be matched with a community in which that voice resonates and thrives.
  • Recognize the value of dialog as the new means by which information is delivered.

Ultimately this comes down to institutional acceptance of how the world is changing.  Doctors are nothing like they were once portrayed and there’s no longer one way to see a physician.

That’s what everyone else needs to understand.

Health 2.0 Houston and the Changing Face of Medicine


The following represents a rough narrative of my opening remarks at the launch of Health 2.0 Houston, January 29th, 2013

Let me be the first to welcome everyone to the launch of Health 2.0 Houston.  This is a huge night for the Houston medical community and anyone concerned with the future of health care.  Congratulations to Brian Lang and Laura Shapland for pulling off a tremendous event.  I’d like to think that it was my link bait promotional tweets that filled the house but I think it was more likely the huge effort that Brian and Laura put into this.  I want to thank them for giving me the opportunity to offer some opening remarks on how medicine is changing and how Health 2.0 Houston factors in.

This is truly the most remarkable time to be in medicine.  I always say that I’m convinced that I was born at just the right time in history.  I was trained as an analog physician but have been a witness to the digital revolution that Eric Topol has called The Creative Destruction of Medicine.  Everything we understand about what it is to be a doctor is changing.  If we were to fast-forward to the year 2050, the work of a physician would be unrecognizable.  We as physicians are being completely redefined.  And here’s how:

  • Technology. What we have traditionally done with our eyes, ears and hands has been replaced by technology.  I believe that we’re truly advancing into an era of post-human medicine.
  • Empowered patient. There has been nothing more powerful in the redefinition of the doctor than the empowered patient.  Patients are changing and they, in turn, are changing us.  For the better part of modern civilization our role as physician has centered around privileged access to information and knowledge.  But the web has created a type of disintermediation.  Patients can do more on their own.  They can share information and adjust what they’re doing based on the input of others.  And the physician encounter is evolving as a more narrowly defined element in an individual’s quest to understand their condition and get better.
  • Information.  And all of this is fueled by information, access to information and our ability to share it.

Despite the changes underway we’re still a profession of information and idea isolation.  Our culture of medicine is one that insists on permission before sharing or creating new ideas.  Many of us still live and work under a 20th century construct of patient care and communication.  Many physicians try to see the future through a rear view mirror.

So we have a lot of work to do to prepare the next generation of physicians.  Howard Rheingold has suggested that this generation needs a new set of literacies in order to survive.  We’re working on it.

I’m privileged to be co-teaching a course at Rice University this spring, Medicine in the Age of Networked Intelligence.  I believe it’s the first course of its kind that aims to teach basic digital literacies to the next generation of provider.  The course is being offered under a new program called the Medical Futures Lab, a collaboration between BCM, Rice and UT that seeks to address the problems facing medicine at the intersection with technology.

I’ll should add that my co-founder, Kirsten Ostherr, is an English professor.  And it makes perfect sense because the solutions to our most pressing health care problems often lie outside the verticals where we’ve traditionally sought answers.  It’s this sort of non-traditional collaboration that will fuel Health 2.0 Houston.  I see this as mixing the best of the Texas Medical Center with the most disruptive minds in health technology.  In the 20th century some of the greatest developments in medicine arose from the institutions of the Texas Medical Center.  The greatest health care innovations in the 21st century may well arise from the bottom or the edges of medicine, facilitated by groups like Health 2.0 Houston.

In closing I’d like to add that while technology has created the foundation for Health 2.0 Houston, the human spirit to build, create, innovate, participate and connect is what will drive it forward.  I look forward to the opportunity of meeting each and every one of you.