What Seth Godin Doesn’t Understand about Twitter

imgresSeth Godin’s post, Noise Tolerant Media, is interesting.  But he frames the Twitter in dated terms.  Twitter as cocktail party?  Sure.  If you work like it’s 2009.

His broken assumption is that Twitter is an information source out of our control.  But Twitter doesn’t make noise.  We make it noisy by whom we choose to let in.  Success with Twitter as an information stream comes from creating a signal.  Stowe Boyd has suggested that the single most important decision we can make in a connected world is who to listen to.  Twitter may be super easy to use, but it takes work and intent to use it right.

To Godin’s credit, there may be something to the serendipity that comes with sampling the stream.  Too tight a signal creates a filter bubble.

Do You Initiate or Respond?

StartButtonSeveral years ago Seth Godin wrote about our modes of daily operation which center around response and initiation.  It’s interesting to look at medicine from this perspective.

In medicine we are all about about response.  At our core, we respond to disease.  On a more granular level we respond to pages, abnormal lab results, and new symptoms in our patients.  We do things when people give us things to do something about.  We get pretty good at this during our training.  Residency is all about responding to throughput.  We learn pretty quickly that the brightest residents are the ones who show up early and check off all their boxes.  We are taught to manage patients.  But managers respond, leaders initiate.

But doctors rarely initiate things.  We don’t see ourselves as leaders.  Probably because we’ve never been trained to start anything.  We walk in lock-step.  Medicine is a permission-based culture.

Of course no one wants a creative anesthesiologist (you may, but that’s another post).  But at some point somewhere, someone has to begin something different.  Checklists have always been important in medicine.  But there have to be those who think about new ways to see the checklist.  At some point the list had to be created, updated and questioned.

More than any time in history this generation of will need doctors with the capacity to break ground.  The Creative Destruction of Medicine isn’t going to go well without professionals who think about how we’re going to put all this technology to good use.

Chris Brogan this morning also wrote about starting.  It’s worth a peek.

A Piece of Paper as a Personal Health Record

GodinI live in a world looking for digital solutions to some of health’s biggest problems.  I love watching this all play out.

So yesterday Seth Godin tells the world that a piece of paper could save your life.  He’s advocating that everyone write down their history and carry it around with them.  Yes, your personal health record on a piece of 8 1/2 by 11 inch paper.  As much as it kills me to admit it, there’s a certain amount of wisdom to this.  And not novel, really.  Patients of mine have been doing this for years.

I see loads of chronically ill children.  What’s remarkable is that there’s no way for me to easily get key elements of their child’s history into the EMR.  Despite the tens of millions  of dollars spent on EPIC, it can’t be done in a way that’s practical.  Sure we could scan their paper summary as a media file, but if you know anything about EPIC, it is probably easier if the patient just kept the paper in their wallet.  What’s more discouraging is that if the child came from another institution with a fancy, competing EMR, it still couldn’t be done very easily.

And I don’t need pie charts, reams of data, exhaustive diaries, books, ‘complete medical records’ or thumb drives.  Just the facts to start with (QS data may be important later).  I might even suggest that patients try to limit their summary to one page, focusing on the major issues.  Physical constraints force to think about what’s important.

What would be really cool would be a nicely done, thoughtful sketchnote graphically detailing key elements of a patient’s history.

It’s remarkable that despite how far we’ve come it still comes down to a piece of paper.  We have such a long way to go.

Book Notes: Stop Stealing Dreams

Our educational system needs rebooting according to Seth Godin’s new e-book, Stop Stealing Dreams.  This is a manifesto which suggests that our system of schooling, once predicated on scarcity of access to information, has been destroyed by the connection economy.  The skills, attitudes, and needs of our graduates have changed dramatically.  Our society and the way we prepare our next generation is being fundamentally changed by the impact of the internet.

“The goal of this manifesto is to create a new set of questions and demands that parents, taxpayers, and kids can bring to the people they’ve chosen, the institution we’ve built and invested our time and money into.  The goal is to change what we get when we send citizens to school.”

This book is not a prescription but a series of provocations.  It is written as a series of blog posts or essays in hopes that they will be shared or rewritten.  I’ve decided that there are far too many ideas here to share in one post.  Here are 3 sections from Stop Stealing Dreams.

Section 11 – To efficiently run a school, amplify fear

School’s industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line.  There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination.

And the flip side of this fear and conformity must be that passion will be destroyed.  There’s no room for someone who wants to go faster, or someone who wants to do something else, or someone who cares about a particular issue.  Move on.  Write it in your notes; there will be a test later.  A multiple-choice test.

Section 29 – The other side of fear is passion

There really are only two tools available to the educator.  The easy one is fear.  Fear is easy to awake, easy to maintain, but ultimately toxic.

The other tool is passion.  A kid in love with dinosaurs or baseball or earth science is going to learn it on her own.  She’s going to push hard for ever more information, and better still, master the thinking behind it.

Passion can overcome fear – the fear of losing, of failing, of being ridiculed.

The problem is that individual passion is hard to scale – hard to fit into the industrial model.  It’s not reliably ignited.  It’s certainly harder to create for large masses of people. Sure, it’s easy to get a convention center filled with delegates to chant for a candidate, and easier still to engage the masses at Wembly Stadium, but the passion that fuels dreams and creates change must come from the individual.

Section 52 – The race to the top (and the alternative)

The real debate if you’re a worker is: do you want a job where they’ll miss you if you’re gone, a job where only you can do it, a job where you get paid to bring yourself (your true self) to work?  Because those jobs are available.  In fact, there’s no unemployment in that area.

OR do you want a job where you’re racing to the bottom – where your job is to do your job, do as you’re told, and wait for the boss to pick you?

School is clearly organized around the second race.  And the problem with the race to the bottom is that you might win.  Being the best of the compliant masses is a safe place (for now).  But the rest?  Not so much.

I read this book in the context of medical education and the way we train physicians.  Of course, not all of it applies to our world of medicine but it’s interesting to think that the process of training doctors isn’t much different.  More and more I believe we’re headed for a dramatic overturn in the way we prepare young people to be doctors.  It’s interesting to think that this book was not written by an educational professional.  It was written by someone who thinks clearly about problems.  Perhaps we need more folks outside of ‘education’ to consider solutions for a floundering system.

It’s amazing that within the course of two weeks I interviewed Cathy Davidson, author of Now You See It, read this manifesto by Seth Godin, and listened to Don Tapscott at SXSW.  All have begun to influence the way I see medicine’s future.  It’s funny how these messages all appeared in my space at the same time.  It’s like I need to do something more with them.

I recommend that everyone read Stop Stealing Dreams.  And it’s free.

Weird Doctors

This week Seth Godin released We Are All Weird, the latest installment in The Domino Project.  Godin suggests that the mass market that defined us over the past couple of generations is dead.  Our cultural orientation toward the center of the bell curve (normal) is progressively giving way to fringe groups that lie away from the center.  The weird have forgone the comfort and efficiency of the norm in order to do what they want and what they think is right.  The rise of the weird has been facilitated by social networks and cheap tools of creativity working in a global economy.

While Godin frames Weird in the context of marketing, his message is applicable to medicine.  Our system has for years cultivated its young to think just as the generation before.  Disruption is discouraged.  We like things just as they are.

But for the first time in history, our global network has given a platform to those in medicine who might not have had a voice.  It has allowed those with divergent views to find one another.  I suspect that just as with mass marketing, the medical industrial complex will show fragmentation of its center based on smart solutions coming from the edge.  In the coming years real medical innovation may very well arise from the creative freedom of the private sector.  Academic medicine desperately needs the culture, energy and free range attitude found at places like the MIT Media Lab.

Jay Parkinson at the Stanford Summit/Medicine 2.0 Congress detailed his own unique story in medicine and captured beautifully the danger of uniform medical thinking.  While I may not always agree with Jay, he’s weird and smart, which is why I find him so relevant.  If you can get your hands on the Stanford Summit footage his remarks are worth your time.

So if you look at doctors up close, we’re all weird.  We’ve just been trained to look one way.

Pick up Seth Godin’s We Are All Weird and look for the corollaries in medicine.  It’s a quick read.  Then tell me if you don’t agree.

Links to We Are All Weird are Amazon affiliate links.

Book Notes: Do the Work from The Domino Project

The latest book from Amazons Domino Project is Do the Work by Steven Pressfield.  It’s occupied with the resistance, or the force that keeps the creative from creating.  This book will help you understand this force that is constantly acting against you and offer a mindset for keeping it at bay (you can’t avoid the resistance, only manage it).

This book echoes the concept of Godin’s Linchpin and Poke the Box.  In fact, I can smell his invisible editorial influence.  I might suggest that the message could have been delivered in a few thousand words.  Either way, Do the Work will empower you to get it done.  Read it if you make things.

I like the minimalist, free will motivation vibe coming from The Domino Project but I’m interested to see what they have in the works.  I’m not sure a one genre publishing operation is sustainable.

Physicians and the Moral Obligation to Create Content

I was thumbing through Seth Godin’s Poke the Box and stumbled on this quote.  I couldn’t help but put it in the context of physicians and their obligation to make content:

I hope we can agree that there’s a moral obligation to be honest, to treat people with dignity and respect, and to help those in need.

I wonder if there’s also a moral obligation to start.

I believe there is.  I believe that if you’ve got the platform and the ability to make a difference, then this goes beyond “should” and reaches the level of “must.”  You must make a difference or you squander the opportunity.  Wasting the opportunity both degrades your own ability to contribute and, more urgently, takes something away from the rest of us.

Once you’ve engaged within organization or a relationship or a community, you owe it to your team to start.  To initiate.  To be the one who makes something happen.

To do less is to steal from them.

That last sentence is compelling.  Perhaps our silence is a crime against patients.  Dramatic, for sure, but does makes me think:  What more could we be doing?

The link to Poke the Box is an Amazon affiliate link.

Book Notes: Poke the Box

Poke the Box is Seth Godin’s latest book/manifesto.  This is different from his other books in that it runs only 70 pages and is published as part of a new venture with Amazon called The Domino Project.  You may remember last year Seth Godin rocked the world by suggesting he was done with mainstream publishers.  This is where he’s landed.

Poke the Box is a short, 70 page manifesto about the importance of starting.  Godin makes the case that the ability to take initiative is a trait that consistently characterizes those who succeed.  The ability to begin creating is what separates the talkers from the doers.  Not making lists, planning, organizing, networking, or amassing followers.  Starting.  There are how-to steps here, just a foundation for taking a new approach to what you do.  This is a sequel to Linchpin.

I struggle with this myself.  Around the first of the year and well before I read Poke the Box I committed to spending a little less time around the water cooler and more time creating.  Thus I’ve been a little less visible on Twitter.  I’m desperately working to shut off distractions.  Poke the Box resonated with me.

Consider this quote about Godin’s friend and Twitter.  It’s worth processing:

Apparently, my friend has set the phone to chime every time one of the people he follows on Twitter posts something. This gives him the chance to read it and respond, making him, presumably, a truly valuable follower. He’s hoping that polishing his relationships in this way will act as a form of networking, making him more integrated into the Tweeters’ lives and perhaps businesses. All this polishing. Stand on an urban street corner and you can see it happening. Dozens of ostensibly busy people, staring at their palms and their fingers, polishing their relationships. The challenge is that it’s asymptotic. Twice as much polishing isn’t twice as good. Ten times as much polishing is definitely not ten times as good. Whether you’re polishing a piece of furniture or an idea, the benefits diminish quickly. The polishing turns into stalling. I wonder what would happen if instead of rushing to Twitter, my friend used that chime to do something original or provocative or important? What if the chime was his reminder not to polish, but to create?

In a way that only Godin can do he marries motivation with raw logic.  I would strongly suggest that if you are in the business of doing or creating, drop what you’re doing (temporarily) and read Poke the Box. It’s a quick read.

The Amazon link above is an affiliate link.

Writing When There’s Something to Say

After last week’s post about Seth Godin and Tom Peters on Blogging, it was suggested in the comments that ‘we should be writing when there’s something to say.

It got me thinking, how do I know when I have something worth sharing?  I don’t.  The value of what I write here is dependent on the eye of the reader.

Or the value may be for me.  Writing can be therapeutic and transformative.  As Godin and Peters suggest, writing can be a way to work through ideas.

So depending upon the day there’s hopefully something here for both of us.

Like most bloggers, I live with the temptation to serve red meat.  I know precisely what draws traffic to 33 charts.  But I want to avoid a vapid barrage of linkbait, lists and SEO optimized titles that promise tactical solutions to our social health woes.  Michael Arrington at Techcrunch has referred to this as social psychomanipulation.  Too often we play to our audience in a way that isn’t healthy.  We involuntarily evolve our writing in response to a feedback loop that tailors content for maximum positive regard.  Short-term it makes for exciting traffic, long-term it stifles fresh thinking.

I’ve got lists and solutions.  But I’m going to try to keep it fresh with ideas that look at medicine and social media as part of something bigger.  I’m not sure it’s worth reading but it’s where I’m at and how I’m thinking.

My 3 Words for 2011

I awoke this morning to this post by Chris Brogan.  He likes to think about 3 words for the New Year that will serve as guidance for his actions and goals.  Not resolutions, but themes.  The concept made me think: What are my 3 words for 2011?

Ship.  The curse of a fertile mind is to create at the expense of execution.  Seth Godin in Linchpin uses ‘ship’ to refer to the final act of execution.  This book influenced me tremendously in 2010.  Scott Belsky in Making Ideas Happen helped me understand that killing some ideas is critical to helping the best ideas flourish and ship.  Killing ideas is a step to simplification.

Simplify.  The idea of the human feed (via David Armano) will continue to become important for me.  I want to work to minimize my inputs and this will involve minimizing distractions and compartmentalizing time on real-time spaces like Twitter.  I am progressively allocating my attention to fewer and fewer, high quality blogs.  Books will evolve as important sources of input.  I will continue to refine who I follow, friend, like and adore.

No.  Demands on my time are becoming greater.  And saying no can be hard because collaboration breeds relationships that can bear fruit.  This is a real temptation that has to be weighed against the urge to get things done and time with my kids.  I’ll be working on no in 2011.

So I’ll simplify and say no so that I can ship in 2011.  We’ll see how it goes.

This is a great exercise.  What are your 3 words?

Seth Godin & Tom Peters on Blogging

I’ve always been secretly uncomfortable with the idea that I see blogging as an outlet.  It’s a way to play with ideas in public – my creative sandbox.  So many experts I read tell me that I should blog with a specific purpose and goal.  I guess I’m still figuring all of this out.

This American Express Open Forum video of Seth Godin and Tom Peters makes me feel better about what I do.  I’ve included text of their brief conversation below.

Seth Godin:  Blogging is free.  It doesn’t matter if anyone reads it.  What matters is the humility that comes from writing it.  What matters is the metacognition of thinking about what you’re going to say.  How do you explain yourself to the few employees or your cat or whoever’s going to look at it.  How do you force yourself to describe in 3 paragraphs why you did something?  How do you respond out loud?  If you’re good at it some people are going to read it.  If you’re not good at it and you stick with it you’ll get good at it.  But this has become much bigger than are you Boing Boing or the Huffington Post.  This has become such a microblogging platform that basically you are doing it for yourself to force yourself to become part of the conversation even if it’s just that big.  And that posture change changes an enormous amount.

Tom Peters:  I will simply say my first post was in August of 2004.  No single thing in the last 15 years professionally has been more important to my life than blogging.  It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook (and it is the best damn marketing tool by an order of magnitude that I’ve ever had).

Seth Godin:  And it’s free.

Tom Peters:  And it’s free.